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[Echocardiographic studies in children with chronic kidney insufficiency and intermittent hemodialysis treatment]
Insights
Hemodialysis in children improves cardiac function by reducing fluid overload, decreasing blood pressure, and improving cardiac output. These positive changes suggest functional, not structural, cardiac alterations in pediatric patients undergoing dialysis.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Physiology
Context:
- Chronic intermittent hemodialysis is a vital treatment for children with kidney failure.
- Assessing cardiac function in these patients is crucial for monitoring treatment efficacy and overall health.
- Pediatric patients undergoing hemodialysis often experience fluid overload and cardiovascular changes.
Purpose:
- To evaluate the impact of chronic intermittent hemodialysis on cardiac function in children.
- To assess changes in blood pressure, cardiac dimensions, and cardiac output before and after hemodialysis.
- To differentiate between functional and structural cardiac alterations in pediatric hemodialysis patients.
Summary:
- Cardiac function was assessed in 10 children undergoing hemodialysis, with measurements including blood pressure, heart rate, and echocardiography.
- Hemodialysis led to reduced body weight and significant decreases in diastolic blood pressure and left ventricular dimensions (LVES, LVED).
- Cardiac output decreased, while heart rate and shortening fraction increased, indicating improved cardiac performance. Changes suggest functional rather than structural cardiac alterations.
Impact:
- Hemodialysis effectively improves cardiac function in children by reducing preload and afterload, suggesting reversible cardiac changes.
- Findings support the management of fluid balance in pediatric hemodialysis to optimize cardiovascular health.
- This study provides insights into the functional adaptations of the pediatric heart during renal replacement therapy.
Abstract:
Cardiac function was measured in 10 children (mean age 12 years) undergoing chronic intermittent hemodialysis. Blood pressure, heart rate and body weight were checked three times before and after hemodialysis. Echocardiographic studies were performed according to the references of the American society of echocardiography. 6 patients were normotensive, 4 patients hypertensive. Cardiac function was normal before and after hemodialysis in all patients. Ultrafiltration reduced body weight on average by 1.2 kg. The mean systolic blood pressure remained unchanged, the mean diastolic blood pressure declined in normotensive patients from 66 mm Hg to 53 mm Hg and in hypertensive patients from 100 to 85 mm Hg on average; the systolic leftventricular diameter (LVES) was reduced by dialysis from 2.7 to 2.3 cm, the enddiastolic leftventricular diameter (LVED) from 4.42 to 4.02. Cardiac output declined from 62.04 ml to 56.68 ml/min, whereas heart rate, shortening fraction and mean circumferential fiber-shortening-time increased. In normotensive patients LVED shortened more (4.4 to 3.86 cm) than in hypertensive children (4.44 to cardiac output 4.18 cm), but there were no significant differences. Significantly decreased only in the normotensive children. In hypertensive children the shortening fraction increased significantly (35.54 to 42.48%) in contrast to normotensive children (40.84 to 38.44%). Cardiac preload (LVES) and (LVED) and afterload (diastolic pressure) was reduced significantly after volume elimination. These changes in cardiac function suggest, that cardiac alterations found before hemodialysis are only functional and not structural.