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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Assessment of Vascular Function in Patients With Chronic Kidney Disease

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Change in cardiac geometry and function in CKD children during strict BP control: a randomized study

Maria Chiara Matteucci1, Marcello Chinali, Gabriele Rinelli

  • 1Departments of Pediatric Nephrology and Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. mchiara.matteucci@opbg.ne

Clinical Journal of the American Society of Nephrology : CJASN
|November 6, 2012
PubMed

Insights

In children with chronic kidney disease (CKD), ACE inhibition improved blood pressure control, leading to reduced left ventricular hypertrophy (LVH) and better systolic function. Intensified blood pressure control showed slightly greater improvements in heart function.

Area of Science:

  • Pediatric Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • Children with chronic kidney disease (CKD) often exhibit left ventricular hypertrophy (LVH) and impaired systolic function.
  • This study investigated cardiac changes in pediatric CKD patients as part of a larger trial on blood pressure control.

Purpose of the Study:

  • To evaluate the impact of strict blood pressure control and ACE inhibition on left ventricular (LV) geometry and systolic function in children with mild to moderate CKD.
  • To compare the effects of conventional versus intensified blood pressure control strategies.

Main Methods:

  • Eighty-four children with CKD underwent echocardiograms and ambulatory BP monitoring at baseline and follow-up (1-2 years).
  • Patients had elevated 24-hour mean BP or were on high-dose ACE inhibitors, randomized to conventional or intensified BP control.
  • Data analyzed for changes in LV mass index (LVMI) and midwall fractional shortening.

Main Results:

  • Prevalence of LVH decreased significantly from 38% to 25% (P<0.05).
  • LVMI reduction occurred in patients with baseline LVH, independent of randomization or BP reduction.
  • Midwall fractional shortening increased in the total cohort (P<0.05), with greater improvement in the intensified BP control group.

Conclusions:

  • ACE inhibition, combined with improved BP control, led to LVH regression and improved systolic function in children with CKD within 12 months.
  • Lowering BP to the low-normal range enhanced myocardial function more than LVMI.
  • Intensified BP control yielded slightly greater improvements in cardiac function compared to conventional control.
Abstract

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