Sugg H Carolina, Cano Sch Francisco
Programa Formación Nefrología Pediátrica, Chile.
Departamento Pediatría y cirugía Infantil Oriente, Facultad de Medicina, universidad de chile, Santiago, Chile.
Rev Chil Pediatr. 2020 Dec;91(6):917-923. doi: 10.32641/rchped.vi91i6.1831. Epub 2020 Dec 12.
There is a close relationship between chronic kidney disease (CKD) and cardiovascular disease. One of its clinical manifestations is left ventricular hypertrophy (LVH), expressed as Left Ventricular Mass Index (LVMI gr/m27). In CKD patients with growth retardation, the LVMI calculation should be adjusted by correcting age for length/height.
To compare the age-corrected LVMI for length/height with the value calculated by chronological age in CKD children on dialysis.
Cross-sectional study. We analyzed echocardiographies of CKD children on dialysis aged between 1 and 18, from January 2016 to July 2017. LVMI was evaluated by adjusting the value expressed in gr/m27 to the percentile for the chronological child's age, and then the value was adjusted to the age-corrected length/height. We used descriptive statistics and concordance study for LVMI assessments calculating by chronological age and for age-corrected length/height.
26 patients were included and 75 echocardiograms. 56% had left ventricular hypertrophy using chronological age versus 46.6% age-corrected LVMI for length/height. When comparing the percentile groups of LVMI-chronological age vs. age-adjusted LVMI for actual length/height, it was observed that 18.6% of the sample changed percentile groups, 100% of them to a lower percentile group. The agreement evaluated based on the Kappa coefficient was 0.72 (perfect agreement > 0.8), confirming differences when adjusting the LVMI for age-corrected length/height.
Calculating LVMI by chro nological age overestimates the cardiovascular involvement in children with CKD who are charac teristically stunted. The results suggest that the age-adjusted, length/height-corrected calculation of LVMI gives greater accuracy to the diagnosis of left ventricular hypertrophy in this group of patients.
慢性肾脏病（CKD）与心血管疾病之间存在密切关系。其临床表现之一是左心室肥厚（LVH），以左心室质量指数（LVMI，g/m².7）表示。在生长发育迟缓的CKD患者中，LVMI的计算应通过根据身长/身高校正年龄来进行调整。
比较经年龄校正的身长/身高LVMI与按实际年龄计算的CKD透析儿童的LVMI值。
横断面研究。我们分析了2016年1月至2017年7月期间年龄在1至18岁的CKD透析儿童的超声心动图。通过将以g/m².7表示的值调整为同年龄儿童的百分位数来评估LVMI，然后将该值调整为经年龄校正的身长/身高。我们对按实际年龄计算的LVMI评估以及经年龄校正的身长/身高进行了描述性统计和一致性研究。
纳入26例患者，共75份超声心动图。按实际年龄计算，56%的患者存在左心室肥厚，而经年龄校正的身长/身高LVMI为46.6%。当比较LVMI实际年龄百分位组与根据实际身长/身高调整年龄后的LVMI时，发现1⃣️8⃣️.6%的样本改变了百分位组，其中100%变为较低的百分位组。基于Kappa系数评估的一致性为0.72（完美一致性>0.8），证实了在根据经年龄校正的身长/身高调整LVMI时存在差异。
按实际年龄计算LVMI会高估具有典型发育迟缓的CKD儿童的心血管受累情况。结果表明，经年龄调整、身长/身高校正的LVMI计算能更准确地诊断该组患者的左心室肥厚。
