Oxidative stress and cardiac dysfunction in children with chronic renal failure on regular hemodialysis

Area of Science:

• Pediatric Nephrology
• Cardiology
• Biochemistry

Background:

• End-stage renal disease (ESRD) in children is associated with increased cardiovascular risk.
• Oxidative stress is implicated in the pathophysiology of cardiovascular complications in ESRD.
• Early detection of cardiac dysfunction is crucial for managing pediatric ESRD patients.

Purpose of the Study:

• To evaluate cardiac function in children with ESRD using speckle tracking echocardiography (STE).
• To correlate cardiac function parameters with plasma glutathione levels as a marker of oxidative stress.
• To assess the utility of STE in detecting subclinical cardiac dysfunction in pediatric ESRD.

Main Methods:

• A case-control study involving 30 children with ESRD on hemodialysis and 30 healthy controls.
• Measurement of plasma glutathione and C-reactive protein (CRP) levels.
• Cardiac function assessment using conventional echocardiography and STE, including global longitudinal strain (GLS) and torsion.

Main Results:

• Children with ESRD exhibited significantly lower glutathione and higher CRP levels compared to controls.
• STE detected significant systolic and diastolic cardiac dysfunctions, including impaired LV and RV GLS and torsion, which conventional echocardiography missed.
• Impaired GLS and torsion negatively correlated with plasma glutathione levels, indicating a link between oxidative stress and cardiac dysfunction.

Conclusions:

• Children with ESRD experience significant oxidative stress, correlating with cardiac dysfunction.
• STE is a sensitive tool for early detection of cardiac abnormalities in pediatric ESRD.
• Oxidative stress plays a key role in the development of cardiac dysfunction in pediatric ESRD.