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Factors associated with reduction of left ventricular mass in children on peritoneal dialysis
Jeong Jin Yu1, Hyun Ok Jun1, Eun Jung Shin1
1Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Fluid volume expansion significantly impacts left ventricular mass reduction in children with end-stage renal disease (ESRD) on peritoneal dialysis. Diastolic function and blood urea nitrogen levels are key indicators in this process.
Area of Science:
- Pediatric Nephrology
- Cardiology in Chronic Illness
- Renal Disease Management
Background:
- Left ventricular hypertrophy (LVH) is a significant complication in children with end-stage renal disease (ESRD).
- Peritoneal dialysis (PD) is a common treatment modality for pediatric ESRD, but its effect on cardiac remodeling requires further investigation.
- Understanding factors influencing left ventricular mass (LVM) changes is crucial for optimizing treatment and improving outcomes in these vulnerable patients.
Purpose of the Study:
- To identify sensitive factors associated with left ventricular mass reduction in pediatric ESRD patients undergoing PD.
- To explore the relationship between clinical and echocardiographic parameters and changes in indexed LVMI.
- To elucidate the role of fluid volume status in cardiac remodeling during PD treatment.
Main Methods:
- A cohort of 35 children with ESRD on PD was studied.
- Two sets of serial echocardiographic and clinical data were collected for each participant.
- Indexed left ventricular mass index (LVMI) and blood pressure were normalized using 95th percentile values for age and sex.
Main Results:
- Systolic blood pressure index and E' velocity were identified as univariate predictors of left ventricular hypertrophy.
- Changes in these predictors did not directly correlate with the change in indexed LVMI.
- Reduction in indexed LVMI was significantly correlated with decreased indexed left atrial volume, reduced trans-mitral A velocity, lower serum blood urea nitrogen, and increased hemoglobin levels.
Conclusions:
- Circulating volume expansion appears to be a primary factor influencing LVMI changes in pediatric ESRD patients on PD.
- Volume-dependent diastolic functional variables are closely related to LVMI modifications.
- Further research with larger cohorts, including fluid volume control groups, is warranted to confirm the role of volume expansion in LVMI changes.
Aim:
This study aimed to investigate sensitive factors involved in left ventricular mass reduction in children with end-stage renal disease (ESRD) undergoing peritoneal dialysis.
Methods:
Thirty-five subjects on peritoneal dialysis were enrolled. Two successive echocardiographic and clinical data for each subject were obtained. Blood pressure and left ventricular mass index (LVMI) were indexed through a division with the normal 95th percentile value. Differences in numeric data between two datasets were calculated.
Results:
The mean age was 12.9 ± 4.6 years. Predictors of left ventricular hypertrophy and its persistence were systolic blood pressure index (P = 0.019 and P = 0.046) and E' velocity (P = 0.035 and P = 0.031) in univariate analysis. However, differences in these predictors between the datasets were not related to the change in indexed LVMI. Reduction in indexed LVMI was correlated to a reduction of indexed left atrial volume (R = 0.638, P = 0.001), trans-mitral A velocity (R = 0.443, P = 0.011), and serum blood urea nitrogen level (R = 0.372, P = 0.028) and an elevation of haemoglobin level (R = -0.374, P = 0.027).
Conclusion:
The extent of circulating volume expansion is potentially the main predictive factor for change of LVMI, because the volume dependent diastolic functional variables correlate to the change of LVMI. Further study with a large number of ESRD children including a group under fluid volume control is needed to investigate the role of volume expansion on the change of LVMI.
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