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Interdialytic weight gain in oligoanuric children and adolescents on chronic hemodialysis
Fabio Paglialonga1, Silvia Consolo, Maria Albina Galli
1Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy, fabiopaglialonga@alice.it.
Insights
Interdialytic weight gain (IDWG) significantly correlates with left ventricular mass index (LVMI) in pediatric oligoanuric hemodialysis patients. High IDWG (>4%) increases the risk of left ventricular hypertrophy in these children.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Complications in Chronic Kidney Disease
- Hemodialysis
Background:
- Limited understanding of interdialytic weight gain (IDWG) clinical impact in oligoanuric children on chronic hemodialysis (HD).
- Assessing the relationship between IDWG and cardiac remodeling in this vulnerable pediatric population.
Purpose of the Study:
- To investigate the association between IDWG and left ventricular mass index (LVMI) in pediatric patients with oligoanuric chronic HD.
- To determine if higher IDWG levels correlate with increased risk of left ventricular hypertrophy (LVH).
Main Methods:
- Retrospective analysis of 16 oligoanuric pediatric patients undergoing chronic HD.
- Assessed IDWG, LVMI, changes in LVMI (ΔLVMI), blood pressure, urine output, and dialysis adequacy (Kt/V).
Main Results:
- Significant correlation found between IDWG and LVMI (r=0.55, p=0.026).
- Patients with IDWG >4% exhibited higher median LVMI (44.3 g/m(2.7)) compared to those with IDWG <4% (27.3 g/m(2.7)) (p=0.003).
- Higher IDWG (>4%) was associated with increased prevalence of LVH (83.3% vs 0%, p=0.003), worse ΔLVMI, and higher diastolic blood pressure.
Conclusions:
- IDWG is significantly correlated with LVMI in pediatric oligoanuric patients on chronic HD.
- An IDWG exceeding 4% identifies children at higher risk for developing left ventricular hypertrophy.
Background:
Little is known about the clinical impact of interdialytic weight gain (IDWG) on oligoanuric children undergoing chronic hemodialysis (HD).
Methods:
We retrospectively assessed IDWG, left ventricular mass index (LVMI) and its changes (ΔLVMI), pre-HD systolic and diastolic blood pressure (DBP), residual urine output, Kt/V, the frequency of intradialytic symptoms, normalized protein catabolic rate, and the 3-month change in the dry weight of 16 hemodialyzed oligoanuric patients with a median age of 14.8 years (range 5.0-17.9).
Results:
There was a significant correlation between IDWG and median LVMI (r 0.55, p = 0.026), which was 27.3 g/m(2.7) (22.5-37.6) in the patients with a median IDWG of <4 %, and 44.3 g/m(2.7) (28.2-68.7) in those with a median IDWG of >4 % (p = 0.003). None of the four patients with an IDWG of <4 % showed left ventricular hypertrophy, compared with 10 of the 12 patients (83.3 %) with an IDWG of >4 % (p = 0.003); the former also had a better median ΔLVMI (-33.5 % vs -13.0 %; p = 0.02) and a lower median DBP sds (0.24 vs 1.72, p = 0.04).
Conclusions:
There is a significant correlation between IDWG and LVMI in pediatric oligoanuric patients on chronic HD: those with an IDWG of >4 % are at a higher risk of left ventricular hypertrophy.
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