Rumman Rawan K, Ramroop Ronand, Chanchlani Rahul, Ghany Mikaeel, Hebert Diane, Harvey Elizabeth A, Parekh Rulan S, Mertens Luc, Grattan Michael
Institute of Medical Science, and the Cardiovascular Sciences Collaborative Program, University of Toronto, Toronto, ON, Canada.
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Nephrol. 2017 Aug;32(8):1401-1410. doi: 10.1007/s00467-017-3622-7. Epub 2017 Mar 8.
Childhood chronic kidney disease (CKD) and dialysis are associated with increased long-term cardiovascular risk. We examined subclinical alterations in myocardial mechanics longitudinally in children with CKD, during dialysis, and following renal transplantation.
Forty-eight children with CKD (stage III or higher) who received kidney transplants from 2008 to 2014 were included in a retrospective study and compared to 192 age- and sex-matched healthy children. Measurements of cardiac systolic and diastolic function were performed, and global longitudinal strain (GLS) and circumferential strain (GCS) were measured by speckle-tracking echocardiography at CKD, during dialysis, and 1 year following kidney transplantation. Mixed-effects modeling examined changes in GLS and GCS over different disease stages.
Children with CKD had a mean age of 10 ± 5 years and 67% were male. Eighteen children received preemptive transplantation. Children with CKD had increased left ventricular mass, lower GLS, and impaired diastolic function (lower E/A ratio and E' velocities) than healthy children. Changes in left ventricular diastolic parameters persisted during dialysis and after renal transplantation. Dialysis was associated with reduced GLS compared to CKD (β = 1.6, 95% confidence interval 0.2-3.0); however, this was not significant after adjustment for systolic blood pressure and CKD duration. Post-transplantation GLS levels were similar to those at CKD assessment. GCS was unchanged during dialysis but significantly improved following transplantation.
There are differences in diastolic parameters in childhood CKD that persist during dialysis and after transplantation. Systolic parameters are preserved, with significant improvement in systolic myocardial deformation following transplantation. The impact of persistent diastolic changes on long-term outcomes requires further investigation.
儿童慢性肾脏病（CKD）和透析与长期心血管风险增加相关。我们纵向研究了CKD儿童、透析期间儿童以及肾移植后的儿童心肌力学的亚临床改变。
一项回顾性研究纳入了2008年至2014年接受肾移植的48例CKD（III期或更高分期）儿童，并与192例年龄和性别匹配的健康儿童进行比较。进行心脏收缩和舒张功能测量，并在CKD期、透析期间以及肾移植后1年通过斑点追踪超声心动图测量整体纵向应变（GLS）和圆周应变（GCS）。混合效应模型研究了不同疾病阶段GLS和GCS的变化。
CKD儿童的平均年龄为10±5岁，67%为男性。18例儿童接受了抢先移植。与健康儿童相比，CKD儿童左心室质量增加、GLS降低且舒张功能受损（E/A比值和E'速度降低）。左心室舒张参数的变化在透析期间和肾移植后持续存在。与CKD相比，透析与GLS降低相关（β=1.6，95%置信区间0.2 - 3.0）；然而，在调整收缩压和CKD病程后，这一差异无统计学意义。移植后GLS水平与CKD评估时相似。透析期间GCS无变化，但移植后显著改善。
儿童CKD的舒张参数存在差异，在透析期间和移植后持续存在。收缩参数得以保留，移植后收缩期心肌变形有显著改善。舒张期持续变化对长期预后的影响需要进一步研究。
Zotero 插件