Assessment of Left Ventricular Geometry in Children with Chronic Kidney Disease Undergoing Peritoneal Dialysis

Yıl 2021, Cilt: 15 Sayı: 4, 325 - 330, 16.07.2021

Emine Azak , Ozan Özkaya

https://doi.org/10.12956/tchd.907536

Öz

Objective: Cardiovascular morbidity seems increased in children with chronic renal failure, but the age and stage of disease when cardiac alterations become manifest are unknown. The aim of our study was aimed to evaluate the left ventricular geometry of children with chronic renal failure (CRF) undergoing peritoneal dialysis.

Material and Methods: Echocardiographic and biochemical data were evaluated in 20 children on peritoneal dialysis (PD). Left ventricular mass index and relative wall thickness was calculated. There were 20 healthy control.

Results: Left ventricular mass index and relative wall thickness were found significantly higher in CRF group compared to control group (respectively 88.03±37.09; 41.16±12.52 and 0.62±0.12; 0.39±0.08, p>0.05). There was significant correlation between left ventricular mass index and systolic blood pressures and parathormone (respectively r=0.428, p=0.03; r=-0.501, p=0.02). An abnormal left ventricular geometric pattern was present in 17/20 (85%) children with CRF. Concentric hypertrophy was the most common geometric pattern in the study. Nine (45%) of patients with CRF had left ventricular concentric hypertrophy. Left ventricular systolic functions were found normal in patients with CRF(EF 65.63±6.71% and FS 35.7±10.25%).

Conclusion: Left ventricular hypertrophy (LVH) can be progresses in children with chronic renal failure. The strict control of blood pressure and hyperparathyroidism might be important in preventing the development of LVH in these patients.

Anahtar Kelimeler

Echocardiography, Peritoneal dialysis, Left ventricular geometry

Periton Diyalizi Programında İzlenen Kronik Böbrek Yetersizlikli Çocuklarda Sol Ventrikül Geometrisinin Değerlendirilmesi

Öz

Amaç: Kronik böbrek yetmezliği (KBY) olan çocuklarda kardiyovasküler morbidite artmıştır. Ancak kardiyak değişikliklerin hastalığın hangi evresinde ortaya tam olarak bilinmemektedir. Bu çalışmada periton diyaliz programında izlenen son dönem böbrek yetmezliği olan çocuklarda sol ventrikül geometrisinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Periton diyalizinde izlenen 20 KBY’li çocukta ekokardiyografik ve biyokimyasal veriler değerlendirildi. Sol ventrikül kitlesi ve rölatif duvar kalınlığı hesaplandı. Kontrol grup olarak 20 sağlıklı çocuk alındı.

Bulgular: Sol ventrikül kitle indeksi ve rölatif duvar kalınlığı KBY grubunda kontrol grubuna göre anlamlı olarak yüksek bulundu (sırasıyla 88.03 ± 37.09; 41.16 ± 12.52 ve 0.62 ± 0.12; 0.39 ± 0.08, p>0.05). Sol ventrikül kitle indeksi ile sistolik kan basıncı ve parathormon arasında anlamlı bir ilişki vardı (sırasıyla r=0.428, p=0.03; r=-0.501, p=0.02). KBY’li 17’sinde (%85) çocukta anormal sol ventrikül geometrisi mevcuttu. Konsantrik hipertrofi, çalışmada en sık anomal sol ventrikül geometrisiydi. Periton diyalizi olan hastaların 9’unda (%45) sol ventrikülde konsantrik hipertrofi izlendi. KBY’li çocuklarda sol ventrikül sistolik fonksiyonları normal sınırlar içindeydi (EF %65.63±6.71 ve FS %35.7±10.25).

Sonuç: Sol ventrikül hipertrofisi (LVH) kronik böbrek yetmezliği olan çocuklarda ilerleyicidir. Kan basıncının ve hiperparatiroidizimin daha yakın kontrolü bu hastalarda LVH gelişimini önlemede önemli olabilir.

Anahtar Kelimeler

ekokardiyografi, periton diyalizi, sol ventrikül geometrisi

Kaynakça

• 1. Groothoff JW, Lilien MR, van der Kar NCAJ, Wolff ED, Davin JC. Cardiovascular disease as a late complication of end-stage renal disease in children. Pediatr Nephrol 2005; 20: 374-79.
• 2. Weaver DJ, Mitsnefes M.Cardiovascular Disease in Children and Adolescents With Chronic Kidney Disease. Semin Nephrol 2018; 38(6):559-69.
• 3. El-Gamasy MA, Mawlana WH. Risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with end-stage renal disease on regular hemodialysis. Saudi J Kidney Dis Transpl 2019; 30(1):53-61.
• 4.Groothoff JW. Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol 2005; 20:849-53.
• 5. Arcari L, Ciavarella GM, Altieri S, Limite LR, Russo D, Luciani M, De Biase L, Mené P, Volpe M.Longitudinal changes of left and right cardiac structure and function in patients with end-stage renal disease on replacement therapy. Eur J Intern Med 2020; 78:95-100.
• 6. Mitsnefes MM, Daniels SR, Schwartz SA, Khoury P, Meyer RA, Strife CF. Severe left ventricular hypertrophy in pediatric dialysis: prevalance and predictors. Pediatr Nephrol 2000; 14:898-902.
• 7.Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek . Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol 1986; 57: 450–58.
• 8.Malikenas A, Cerniauskiene V, Jakutovic M, Jankauskiene A. Left ventricular geometry in children with chronic renal failure. Medicina (Kaunas) 2005; 41 Suppl 1:5-11.
• 9. Parekh RS, Carrol CE,Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 2002; 141:191–7.
• 10. Scavarda VT, Pinheiro AC, Costa SD, de Andrade ZM, Carvalhaes JT, Campos O, et al. Carvalho AC, Moises VA.Children with chronic renal disease undergoing dialysis or conservative treatment differences in structural and functional echocardiographic parameters. Echocardiography 2014; 31(9):1131-7.
• 11. Schoenmaker NJ, Kuipers IM, van der Lee JH, Tromp WF, van Dyck M, Gewillig M, et al. Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study. Cardiol Young 2014; 24(2):236-44.
• 12. Goicoechea M, Garcia de Vinuesa S, Gomez-Campdera F, Luno J. Predictive cardiovascular risk factors in patients with chronic kidney disease. Kidney Int 2005; 67(Suppl 93): 35-8.
• 13. Mitsnefes MM. Cardiovascular complications of pediatric chronic kidney disease. Pediatr Nephrol 2008; 23:27-39.
• 14. Hayashi SY, Rohani M, Lindholm B, Brodin LA, Lind B, Barany P et al. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant 2006; 21:125-32.
• 15. Dogan CS, Akman S, Simsek A, Ozdem S, Comak E, Gokceoglu AU, et al. Assessment of left ventricular function by tissue Doppler echocardiography in pediatric chronic kidney disease. Ren Fail 2015; 37(7):1094-9.
• 16. Atalay S, Ekim M, Tutar HE, Kocak G, Bakkaloglu S, Tümer N. Systolic and diastolic function in children with chronic renal failure. Pediatr Int 2002; 44:18-23.
• 17. Mitsnefes MM, Daniels SR, Schwartz SM, Khoury P, Strife CF. Changes in left ventricular mass in children and adolescents during chronic dialysis. Pediatr Nephrol 2001;16:318-23.
• 18. Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D et al. Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobin. Am J Kidney Dis 1999; 34:125-34.
• 19. Bircan Z,Duzova A,Çakar N,Bayazıt AK, Elhan A, Tutar E, et al. Predictors of left ventricular hypertrophy in children on choronic peritoneal dialysis. Pediatr Nephrol 2010; 25:1311-18.
• 20. Melhem N, Savis A, Wheatley A, Copeman H, Willmott K, Reid CJD, et al. Improved blood pressure and left ventricular remodelling in children on chronic intermittent haemodialysis: a longitudinal study. Pediatr Nephrol 2019; 34(10):1811-20.
• 21. Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR et al. Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 2006; 149:671-5.
• 22. Mitsnefes MM, Daniels SR, Schwartz SA, Khoury P, Meyer RA, Strife CF. Severe left ventricular hypertrophy in pediatric dialysis: prevalance and predictors. Pediatr Nephrol 2000; 14:898-902.
• 23.Shamszad P, Slesnick TC, Smith EO, Taylor MD, Feig DI.Association between left ventricular mass index and cardiac function in pediatric dialysis patients. Pediatr Nephrol 2012; 27(5):835-41.
• 24. Kobayashi D, Patel SR, Mattoo TK, Valentini RP, Aggarwal S.The impact of change in volume and left-ventricular hypertrophy on left-ventricular mechanical dyssynchrony in children with end-stage renal disease. Pediatr Cardiol 2012; 33(7):1124-30.
• 25. Bakkaloglu S, Borzych D, Ha S, Serdaroglu E, Büscher R, Salas P.Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis: Findings from the International Pediatric Peritoneal Dialysis Network (IPPN) Registry. Clin J Am Soc Nephrol 2011; 6(8):1926–33.
• 26. Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR et al. Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 2005;16:2796-803.