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Evaluation of the coronary circulation and calcification in children on regular hemodialysis

Mohammed Al-Biltagi1,2, Maher Ahmed Abd ElHafez3, Doaa Mohamed El Amrousy3

  • 1Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbia, Egypt. mbelrem@hotmail.com.

Pediatric Nephrology (Berlin, Germany)
|May 13, 2017
PubMed

Insights

Children with end-stage renal disease (ESRD) have impaired coronary blood flow and increased coronary artery calcification (CAC). High blood pressure and longer hypertension duration are key risk factors for poor coronary circulation in these patients.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Research
  • Medical Imaging

Background:

  • End-stage renal disease (ESRD) significantly impacts pediatric health.
  • Cardiovascular complications are a major concern in children with ESRD undergoing hemodialysis.
  • Evaluating coronary circulation and calcification is crucial for risk stratification.

Purpose of the Study:

  • To assess coronary blood flow and coronary artery calcification (CAC) in children with ESRD on hemodialysis.
  • To identify predictors of impaired coronary circulation and CAC in this vulnerable population.

Main Methods:

  • Study included 50 children with ESRD and 50 healthy controls.
  • Echocardiography (conventional and tissue Doppler) assessed cardiac function and coronary blood flow.
  • High-resolution multidetector computed tomography (CT) evaluated coronary artery calcification (CAC).

Main Results:

  • Patients with ESRD showed significantly lower hyperemic coronary flow volume (CFV) and coronary flow reserve compared to controls.
  • Hypertension was prevalent (60%), with 20% of ESRD children having CAC, rising to 30% in the hypertensive subgroup.
  • Left ventricle myocardial performance index (LV MPI), CAC score, hypertension duration, and diastolic blood pressure predicted coronary blood flow; LV MPI, parathyroid hormone, dialysis duration, and E'/A' mitral valve predicted CAC.

Conclusions:

  • High diastolic blood pressure, prolonged hypertension, elevated LV MPI, and increased CAC scores are independent risk factors for reduced coronary blood flow in pediatric ESRD.
  • These findings highlight the importance of managing cardiovascular risk factors in children with ESRD.
Abstract

Keywords:
Cardiovascular complicationCoronary calcificationCoronary circulationEchocardiographyEgyptian childrenEnd-stage renal failureRegular hemodialysis

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