Dialysis-associated morbidity, ultrafiltration, and cardiovascular variables in children with HIV infection

Children infected with HIV on maintenance hemodialysis (HD) have increased mortality with adequate single pool Kt/V, as compared to non-HIV children on HD. It is unclear if HIV subjects on HD have similar dialysis-associated morbidity (DAM) and blood volume changes (dBV) as non-HIV subjects. It is also unclear how those variables are related to left ventricular mass index (LVMI), shortening fraction (SF), pre- and postdialysis blood pressure and mortality.

We investigated the relationship between LVMI, SF and dBV and DAM using noninvasive monitoring of hematocrit in HIV vs. non-HIV subjects and their association with mortality. We used a cross-sectional study design and analyzed 18 pediatric subjects (9 had vertically transmitted HIV) on HD over a 17-month period. HIV subjects tolerated fluid removal during HD treatments as well as non-HIV subjects.

In our study we confirmed an association of LVMI with DAM in subjects on HD. We found that HIV subjects who did not survive had a significantly lower SF and similar viral load as compared to subjects who survived.

Noninvasive monitoring of hematocrit in HIV subjects with compromised heart function allows effective ultrafiltration. Routine echocardiography should be periodically performed in all HIV-infected children on renal replacement therapy because subclinical abnormalities, i.e. increased LVMI or reduced SF in this population can be predictors of mortality.