Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
BMC Nephrol. 2020 Dec 9;21(1):533. doi: 10.1186/s12882-020-02152-6.
Cardiovascular disease (CVD) is the most common cause of mortality in pediatric chronic kidney disease (CKD) patients. Left ventricular (LV) hypertrophy (LVH) is associated with LV diastolic dysfunction (LVDD) development and is used as an early marker of CVD in pediatric CKD. This study aimed to assess the prevalence and risk factors of LVDD and the association between LVH and LVDD in Korean pediatric CKD patients.
Data were collected using the baseline data of the Korean cohort study for outcome in patients with pediatric chronic kidney disease, a nationwide, 10-year, prospective, observational cohort study of pediatric CKD. A total of 244 patients were included in the final analysis. Two-dimensional echocardiography and tissue Doppler images were used to evaluate LVH and LVDD. LVH was defined as an LV mass index (LVMI) ≥38 g/m and LV-wall thickness z-score > 1.64. LVDD was defined as a mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E') > 14. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors of LVDD.
In this study, the male-to-female ratio was 2.2 (168:76) and median age was 11.2 years. The average estimated glomerular filtration rate was 57.4 ml/min/1.73 m, and no patients received renal replacement therapy. The mean value of LVMI and E/E' was 37.0 g/m and 7.4, respectively. The prevalence of LVH was 40.1 and 17.4% by LVMI ≥38 g/m and LV-wall thickness z-score, respectively. The prevalence of LVDD was 4.5%, and patients with LVH showed greater risk of LVDD (odds ratio 7.3, p = 0.012). In the univariate analysis, young age, low hemoglobin level, higher LVMI, and higher LV-wall thickness z-score were associated with LVDD. In the multivariate analysis, young age, low hemoglobin level, and higher LV-wall thickness z-score were independently associated with LVDD.
This study shows that LVH patients have a greater risk of LVDD and that anemia is the only modifiable risk factor for LVDD in Korean pediatric CKD patients.
心血管疾病（CVD）是儿科慢性肾脏病（CKD）患者死亡的最常见原因。左心室（LV）肥厚（LVH）与 LV 舒张功能障碍（LVDD）的发展相关，并且被用作儿科 CKD 中 CVD 的早期标志物。本研究旨在评估韩国儿科 CKD 患者 LVDD 的患病率和危险因素，以及 LVH 与 LVDD 之间的相关性。
数据来自韩国儿科 CKD 患者结局的全国性、10 年、前瞻性、观察性队列研究的基线数据。共纳入 244 例患者进行最终分析。使用二维超声心动图和组织多普勒图像评估 LVH 和 LVDD。LVH 定义为左心室质量指数（LVMI）≥38g/m2 和左心室壁厚度 z 评分＞1.64。LVDD 定义为二尖瓣早期充盈峰值速度与早期舒张期二尖瓣环速度（E/E'）之比＞14。进行单变量和多变量逻辑回归分析以评估 LVDD 的危险因素。
本研究中，男女比例为 2.2（168:76），中位年龄为 11.2 岁。平均估算肾小球滤过率为 57.4ml/min/1.73m2，无患者接受肾脏替代治疗。LVMI 和 E/E'的平均值分别为 37.0g/m2和 7.4。通过 LVMI≥38g/m2 和左心室壁厚度 z 评分分别有 40.1%和 17.4%的患者存在 LVH。LVDD 的患病率为 4.5%，LVH 患者发生 LVDD 的风险更高（比值比 7.3，p=0.012）。单变量分析中，年龄较小、低血红蛋白水平、较高的 LVMI 和较高的左心室壁厚度 z 评分与 LVDD 相关。多变量分析中，年龄较小、低血红蛋白水平和较高的左心室壁厚度 z 评分与 LVDD 独立相关。
本研究表明，LVH 患者发生 LVDD 的风险更高，并且贫血是韩国儿科 CKD 患者发生 LVDD 的唯一可改变的危险因素。
