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Renal Effect on Children's Heart (REACH), a prospective observational study on cardiac dysfunction among paediatric
Nur Aida Adnan1, Yok Chin Yap1, Amelia Bt Alias2
1Nephrology Unit, Department of Paediatrics, Tunku Azizah Women and Children Hospital, Kuala Lumpur, Malaysia.
Insights
Children with chronic kidney disease (CKD) show high rates of heart problems like left ventricular hypertrophy and dysfunction. These cardiac issues significantly increase their risk of cardiovascular events and death.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Cardiorenal Medicine
Background:
- Cardiorenal syndrome is well-documented in adults, but poorly understood in children with chronic kidney disease (CKD).
- Assessing cardiac abnormalities in pediatric CKD is crucial for understanding cardiorenal syndrome.
- Limited data exists on cardiac dysfunction prevalence and cardiovascular event incidence in pediatric CKD patients.
Purpose of the Study:
- To determine the prevalence of left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and left ventricular systolic dysfunction (LVSD) in children with CKD.
- To evaluate the incidence of cardiac events in this pediatric population over a 6-month follow-up period.
- To identify associations between cardiac abnormalities and clinical factors in children with CKD.
Main Methods:
- Recruited children aged 2-18 years with estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73 m² or on dialysis.
- Performed transthoracic echocardiography to assess left ventricular mass, systolic, and diastolic function.
- Conducted anthropometric assessment, serum measurements, and a 6-month follow-up for cardiac events.
Main Results:
- Prevalence rates were 42.2% for LVH, 15.6% for LVDD, and 8.9% for LVSD among 45 children.
- LVDD was associated with LVH, LVSD, and higher left ventricular mass index Z-score.
- LVH correlated with hypertension and inadequate blood pressure control; LVDD linked to lower BMI Z-score and serum albumin.
Conclusions:
- Structural and functional cardiac changes are highly prevalent in children with CKD.
- These cardiac abnormalities place pediatric CKD patients at significant risk for cardiovascular events and mortality.
- Early detection and management of cardiac dysfunction are critical in pediatric CKD care.
Background:
While the presence of cardiorenal syndrome in the adult population is well-documented, there is limited understanding of cardiorenal syndrome in paediatric patients with chronic kidney disease (CKD). Our objective was to assess the prevalence of left ventricular hypertrophy, left ventricular diastolic dysfunction, and left ventricular systolic dysfunction in children with CKD. Additionally, we conducted follow-up evaluations to track the incidence of cardiac events.
Methods:
We recruited children aged 2-18 years old with estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73 m2 or on dialysis, and performed transthoracic echocardiography to evaluate the left ventricular mass and left ventricular systolic and diastolic function. They underwent anthropometric assessment and serum measurement at baseline, and were followed up for 6 months.
Results:
Among 45 children recruited, 33 (73.3%) were on dialysis, 28 (84.8%) of whom were on peritoneal dialysis. The prevalences of left ventricular hypertrophy, left ventricular diastolic dysfunction, left ventricular systolic dysfunction were 42.2%, 15.6%, and 8.9%, respectively. Concomitant left ventricular diastolic dysfunction and left ventricular systolic dysfunction were present in 6.7% of children. The presence of left ventricular diastolic dysfunction was significantly associated with left ventricular hypertrophy (P < .001), left ventricular systolic dysfunction (P < .001), and higher left ventricular mass index Z score (P < .001). Left ventricular hypertrophy was associated with the presence of hypertension (P = .035) and inadequate blood pressure (BP) control (P = .033), while left ventricular diastolic dysfunction was associated with lower body mass index (BMI) z score (P = .01) and lower serum albumin (P = .045). Over a 6-month follow up period, 52.6% of children with left ventricular hypertrophy and 71.4% with left ventricular diastolic dysfunction developed a cardiovascular event or died.
Conclusion:
Structural and functional cardiac changes are highly prevalent among children with CKD, putting them at significant risk of cardiovascular events and death.
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