Mudi Abdullahi, Ntsinjana Hopewell, Dickens Caroline, Levy Cecil, Ballot Daynia
Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
Nephron. 2017;136(3):233-242. doi: 10.1159/000470858. Epub 2017 Apr 13.
In children with chronic kidney disease (CKD), fetuin-A and fibroblast growth factor-23 (FGF-23) have been implicated in the mechanism and progression of several cardiac changes. This study aimed to determine the types and rates of cardiac changes in children with CKD and their association with fetuin-A, FGF-23, and other cardiovascular risk factors (CVRFs).
This comparative cross-sectional study recruited 88 children (5-18 years): 27 CKD I with a glomerular filtration rate (GFR) >90 mL/min/1.73 m2 and 61 with a GFR of <90 mL/min/1.73 m2 (29 CKD II-IV, 32 CKD V-dialysis). Each patient had a short demographic and clinical history taken along with a physical examination. Blood was taken and sent for routine tests and for fetuin-A and FGF-23 assay. All patients had an echocardiogram to evaluate cardiac structure and function.
The distribution of left atrial diameter (LAD) and left ventricular (LV) mass differed significantly (p < 0.05) across the different CKD groups. Abnormal LAD was seen in 10% of patients; LV hypertrophy (LVH) in 27%; LV systolic dysfunction in 6% and diastolic dysfunction in 1 patient. Fetuin-A was the only independent predictor for abnormal LAD; mean arterial pressure was independently associated with concentric LVH, and age and hypoalbuminemia with eccentric LVH. Overall, the dialysis group had the highest rate of cardiac changes and associated risk factors.
Though not common, the importance of left atrial changes in children with CKD is highlighted along with the need to address modifiable CVRFs such as hypertension and hypoalbuminemia.
在慢性肾脏病（CKD）患儿中，胎球蛋白-A和成纤维细胞生长因子-23（FGF-23）与多种心脏改变的机制及进展有关。本研究旨在确定CKD患儿心脏改变的类型和发生率，以及它们与胎球蛋白-A、FGF-23和其他心血管危险因素（CVRFs）的关联。
这项比较性横断面研究招募了88名儿童（5 - 18岁）：27名CKD I期患儿，肾小球滤过率（GFR）>90 mL/min/1.73 m²，61名GFR<90 mL/min/1.73 m²的患儿（29名CKD II - IV期，32名CKD V期 - 透析）。为每位患者采集简短的人口统计学和临床病史，并进行体格检查。采集血液并送去进行常规检查以及胎球蛋白-A和FGF-23检测。所有患者均进行超声心动图检查以评估心脏结构和功能。
不同CKD组间左心房直径（LAD）和左心室（LV）质量的分布存在显著差异（p<0.05）。10%的患者出现LAD异常；27%的患者出现左心室肥厚（LVH）；6%的患者出现左心室收缩功能障碍，1名患者出现舒张功能障碍。胎球蛋白-A是LAD异常的唯一独立预测因素；平均动脉压与向心性LVH独立相关，年龄和低白蛋白血症与离心性LVH独立相关。总体而言，透析组心脏改变及相关危险因素的发生率最高。
尽管不常见，但CKD患儿左心房改变的重要性得到凸显，同时也强调了应对可改变的CVRFs（如高血压和低白蛋白血症）的必要性。
