Avendt Mary B, Taylor Michael D, Mitsnefes Mark M
Clin Nephrol. 2018 Sep;90(3):172-179. doi: 10.5414/CN109271.
Assessment of cardiovascular structure and dysfunction is imperative as cardiovascular disease (CVD) is a major cause of morbidity and mortality in pediatric patients with end-stage renal disease (ESRD). Cardiac magnetic resonance allows for accurate measurement of myocardial volumes, global function, and regional deformation (strain). We studied 38 patients aged from 11 to 26 years: 10 on hemodialysis (HD), 10 on peritoneal dialysis (PD), and 18 post renal transplantation (RT). First, we found no difference in the amount of left ventricular hypertrophy among the three cohorts, but we did find uncontrolled hypertension and black race to be independently associated with increased normalized left ventricular mass. We found left ventricular ejection fraction (LVEF) to be significantly higher in patients after RT compared to those on HD. There was no significant difference in peak systolic circumferential strain (Ecc) among the 3 groups, however, 7 of 9 participants with normal LVEF had low Ecc. We also found a strong association between uncontrolled hypertension and reduced Ecc. These findings indicate the presence of subclinical cardiac dysfunction and the importance of proper management of hypertension in pediatric patients with ESRD. .
