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Updated: Aug 28, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Echocardiogram screening in pediatric dialysis and transplantation
Amelia K Le Page1,2, Naganandini Nagasundaram3, Ari E Horton4,5,6
1Department of Nephrology, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia. Amelia.LePage@monashhealth.org.
Insights
Echocardiography effectively detects cardiac issues in children with chronic kidney failure (KF), including increased left ventricular mass and altered systolic strain. Further research is needed to link these findings to long-term outcomes and guide interventions.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Diagnostic Imaging
Background:
- Childhood chronic kidney failure (KF) frequently presents with cardiac abnormalities.
- Left ventricular mass (LVM) increase is common and can persist post-transplant, especially with comorbidities like hypertension and obesity.
- Systolic strain, detectable by speckle tracking echocardiography, is prevalent in children with KF on dialysis and may persist post-transplant.
Purpose of the Study:
- To review the role of echocardiography in identifying cardiac abnormalities in pediatric chronic kidney failure.
- To discuss the association of echocardiographic findings with long-term outcomes and cardiovascular events.
- To evaluate the potential of echocardiography, including newer modalities, as a screening tool in this population.
Main Methods:
- Review of existing literature on echocardiography in childhood chronic kidney failure.
- Analysis of associations between echocardiographic parameters (LVM, systolic/diastolic function, strain) and clinical outcomes in adult and pediatric populations.
- Consideration of interventions impacting cardiac status in pediatric KF.
Main Results:
- Increased LVM is the most frequent finding in pediatric KF, often persisting post-transplant.
- Systolic dysfunction and strain are common in dialysis patients and may persist post-transplant.
- Adult studies show links between echocardiographic abnormalities and adverse cardiovascular outcomes, but this is understudied in children.
Conclusions:
- Echocardiography is a justified screening tool for children with chronic kidney failure.
- Extending screening to include speckle tracking echocardiography and intradialytic studies in high-risk groups is warranted.
- Further longitudinal studies are needed to establish definitive recommendations for echocardiography use and interventions in pediatric KF.
Abstract:
Transthoracic echocardiography is commonly used to identify structural and functional cardiac abnormalities that can be prevalent in childhood chronic kidney failure (KF). Left ventricular mass (LVM) increase is most frequently reported and may persist post-kidney transplant especially with hypertension and obesity. While systolic dysfunction is infrequently seen in childhood chronic KF, systolic strain identified by speckle tracking echocardiography has been frequently identified in dialysis and it can also persist post-transplant. Echocardiogram association with long-term outcomes has not been studied in childhood KF but there are many adult studies demonstrating associations between increased LVM, systolic dysfunction, strain, diastolic dysfunction, and cardiovascular events and mortality. There has been limited study of interventions to improve echocardiogram status. In childhood, improved blood pressure has been associated with better LVM, and conversion from hemodialysis to hemodiafiltration has been associated with better diastolic and systolic function. Whether long-term cardiac outcomes are also improved with these interventions is unclear. Echocardiography is a well-established technique, and regular use in childhood chronic KF seems justified. A case can be made to extend screening to include speckle tracking echocardiography and intradialytic studies in high-risk populations. Further longitudinal studies including these newer echocardiogram modalities, interventions, and long-term outcomes would help clarify recommendations for optimal use as a screening tool.
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