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Updated: Jul 4, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Subclinical systolic dysfunction in pediatric patients with chronic kidney disease
Donald J Weaver1, Thomas Kimball, Sandra A Witt
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Insights
Children with chronic kidney disease (CKD) undergoing hemodialysis show reduced midwall shortening (mwSF), indicating subclinical systolic dysfunction. This finding highlights potential risks for developing severe cardiac disease in pediatric CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Pediatrics
Background:
- Midwall shortening (mwSF) is a key indicator of myocardial performance, particularly in left ventricular hypertrophy (LVH).
- Assessing mwSF in pediatric chronic kidney disease (CKD) is crucial for understanding cardiac health in this vulnerable population.
Purpose of the Study:
- To evaluate midwall shortening (mwSF) in pediatric patients across various stages of chronic kidney disease (CKD).
- To compare mwSF in children undergoing hemodialysis, kidney transplant recipients, and healthy controls.
Main Methods:
- Echocardiographic assessment of left ventricular (LV) geometry and function in 57 children with CKD (stages 2-4), 25 on hemodialysis, 49 transplant recipients, and 35 healthy controls.
- Comparison of mwSF and other LV function indices between patient groups and controls.
Main Results:
- Patients on hemodialysis exhibited significantly lower mwSF compared to controls and CKD stages 2-4 patients (P < .01).
- Renal transplant recipients also showed lower mwSF than controls (P < .01).
- Abnormal mwSF prevalence was highest in hemodialysis patients (40%) versus transplant recipients (12%) and CKD stages 2-4 patients (9%; P = .03).
Conclusions:
- Children on maintenance hemodialysis and those with concentric LVH demonstrate subclinical systolic dysfunction.
- This subclinical dysfunction may signal an increased risk for developing more severe cardiac conditions.
Objectives:
Midwall shortening (mwSF) is thought to be a more accurate measure of myocardial performance in the presence of left ventricular hypertrophy (LVH). We examined mwSF in pediatric patients with varying degrees of chronic kidney disease (CKD).
Study Design:
Fifty-seven children with CKD stages 2 to 4, 25 who were undergoing hemodialysis and 49 who were transplant recipients, were compared with 35 healthy control subjects. Left ventricular (LV) geometry and indices of LV function were assessed echocardiographically.
Results:
There were no significant differences in LV contractility or endocardial shortening fraction between patients and control subjects. Yet, patients undergoing hemodialysis had significantly lower mwSF compared with control subjects (P < .01) and patients with stage 2 to 4 CKD (P < .01). Renal transplant patients had lower mwSF compared with control subjects (P < .01). The prevalence of abnormal mwSF (ie, <16) was significantly higher in patients undergoing hemodialysis (40%) compared with patients who were renal transplant recipeints (12%) and patients with CKD stages 2 to 4 (9%; P = .03). With stepwise regression, mwSF was demonstrated to be predicted by using relative wall thickness (P < .0001), dialysis group (P = .005), and endocardial shortening fraction (P = .001; model R(2) = 0.86).
Conclusions:
Children undergoing maintenance hemodialysis and children with concentric LVH have subclinical systolic dysfunction, which might be an indicator for the development of more severe cardiac disease.
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