El-Gamasy Mohamed A, Mawlana Wegdan H
Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta City, Gharbia Governate, Egypt.
Saudi J Kidney Dis Transpl. 2019 Jan-Feb;30(1):53-61.
Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). The aim of this work was to study the risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with ESRD under regular hemodialysis (HD). Sixty-six children with ESRD on regular HD were included and subjected to history, clinical, laboratory, chest X-rays (CXR), ECG, and two-dimensional echocardiographic study to measure different echocardiographic parameters focusing on the left ventricular ejection fraction. Ninety-two percent of the patients had a cardiovascular risk factor (62.1% hypertension, 37.9% anemia, 12.1% body mass index >95 percentile, 63% serum phosphorus >5.5 mg/dL, and 57.5% calcium-phosphorus product ≥55 mg/dL). A diagnosis of cardiac disease was reported in 16 (24.2%) of all studied patients, the diagnostic methods used were CXR in 39 (59 %), echocardiograms in 23 (34.8%), and electrocardiograms in 21 (31.8%), left ventricular hypertrophy/ enlargement was reported in 12 (75%) of cardiac patients, congestive heart failure/pulmonary edema in 11 (68.8%) of cardiac patients, cardiomyopathy in one (6.3%) of cardiac patients and decreased left ventricular function in one (6.3%) of cardiac patients. Ninety-two percent of patients had cardiovascular risk factors. Diagnosis of cardiac disease was reported in about a quarter of all studied patients. An echocardiography reported the left ventricular dysfunction in 12 (75%) of cardiac dialysis patients. The present study stresses the importance of echocardiography as the gold standard for the diagnosis of cardiac disease in pediatric patients under maintenance HD as a high-risk population for cardiac diseases.
心脏疾病是终末期肾病（ESRD）患儿发病和死亡的重要原因。本研究旨在探讨接受定期血液透析（HD）的埃及儿科ESRD患者心脏疾病的危险因素及患病率。纳入66例接受定期HD的ESRD患儿，进行病史、临床、实验室、胸部X线（CXR）、心电图及二维超声心动图检查，以测量不同的超声心动图参数，重点关注左心室射血分数。92%的患者存在心血管危险因素（62.1%为高血压，37.9%为贫血，12.1%的体重指数>第95百分位数，63%的血清磷>5.5mg/dL，57.5%的钙磷乘积≥55mg/dL）。所有研究患者中，16例（24.2%）被诊断为心脏疾病，诊断方法中，39例（59%）采用CXR，23例（34.8%）采用超声心动图，21例（31.8%）采用心电图，12例（75%）心脏疾病患者报告有左心室肥厚/扩大，11例（68.8%）心脏疾病患者报告有充血性心力衰竭/肺水肿，1例（6.3%）心脏疾病患者报告有心肌病，1例（6.3%）心脏疾病患者报告有左心室功能下降。92%的患者有心血管危险因素。约四分之一的研究患者被诊断为心脏疾病。超声心动图报告12例（75%）心脏透析患者存在左心室功能障碍。本研究强调了超声心动图作为维持性HD儿科患者心脏疾病诊断金标准的重要性，因为该人群是心脏疾病的高危人群。
