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Long-term evaluation of cardiac function utilizing systolic time intervals in children with chronic renal failure
Insights
Children with chronic renal failure (CRF) often develop subclinical uremic heart disease during hemodialysis (HD). Cardiac function typically improves after successful renal transplantation (TP), suggesting resolution of heart disease.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Cardiovascular Physiology
Background:
- End-stage chronic renal failure (CRF) in children can lead to significant health complications.
- Uremic cardiomyopathy is a recognized concern in patients with advanced kidney disease.
- Non-invasive assessment of cardiac function is crucial for early detection of heart issues.
Purpose of the Study:
- To evaluate cardiac function in pediatric patients with end-stage CRF.
- To assess changes in left ventricular performance during conservative treatment (CT), hemodialysis (HD), and after renal transplantation (TP).
- To identify subclinical cardiac dysfunction in children undergoing treatment for CRF.
Main Methods:
- Prospective longitudinal study involving 11 children with end-stage CRF.
- Non-invasive mechanocardiography used to determine systolic time intervals.
- Measurement of the pre-ejection period to left ventricular ejection time (PEP/LVET) ratio at different disease stages.
Main Results:
- The PEP/LVET ratio, an indicator of left ventricular performance, was elevated in children on CT and significantly increased during hemodialysis (HD).
- Impaired cardiac function, indicated by increased PEP/LVET, was subclinical and not clinically apparent.
- Following successful renal transplantation (TP), the PEP/LVET ratio normalized, suggesting recovery of cardiac function.
Conclusions:
- Subclinical uremic heart disease is prevalent in pediatric patients undergoing hemodialysis.
- Hemodialysis is associated with impaired left ventricular performance in children with CRF.
- Renal transplantation appears to resolve the cardiac dysfunction associated with uremic heart disease in this population.
Abstract:
Cardiac function was assessed in 11 children with end-stage chronic renal failure (CRF) by a prospective longitudinal study. Left ventricular performance was determined noninvasively by mechanocardiographic determination of systolic time intervals during three consecutive stages of the disease: on conservative treatment (CT), on regular hemodialysis (HD) and after successful renal transplantation (TP). The mean ratio of the pre-ejection period to left ventricular ejection time (PEP/LVET) was slightly increased on CT (0.33) compared to normal (0.29), and markedly increased 6 and 12 months after start of HD (0.38 and 0.40, respectively), indicating impairment of left ventricular performance which was clinically undetectable. 12 months after TP mean PEP/LVET was normal (0.31). The upper normal limit of PEP/LVET was exceeded by two children on CT, seven at 12 months after start of HD and by two children 12 months after TP, respectively. It is concluded that subclinical forms of uremic heart disease are common in children on HD and tend to resolve after TP.