Subclinical Systolic Dysfunction in Pediatric Patients with Chronic Kidney Disease

Weaver, Donald J.; Kimball, Thomas; Witt, Sandra A.; Glascock, Betty J.; Khoury, Phillip R.; Kartal, Janis; Mitsnefes, Mark M.

doi:10.1016/j.jpeds.2008.04.026

« Previous Next »The Journal of Pediatrics
Volume 153, Issue 4 , Pages 565-569, October 2008

Subclinical Systolic Dysfunction in Pediatric Patients with Chronic Kidney Disease

This study was initially presented in abstract form at the American Society of Nephrology Annual Meeting in October 2007. Research was supported by grants (2K12HD28827 and K23 HL69296-01) from the National Institutes of Health (M.M.). The authors declare no conflicts of interest.

Donald J. Weaver Jr, MD
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Thomas Kimball, MD
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Sandra A. Witt, RDCS
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Betty J. Glascock, RDCS
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Phillip R. Khoury, MS
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Janis Kartal, RN
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Mark M. Mitsnefes, MD, MS
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Reprint requests: Mark Mitsnefes, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, MLC 7022, Cincinnati OH 45229

Received 14 December 2007; received in revised form 15 February 2008; accepted 7 April 2008. published online 27 May 2008.

Objectives

Midwall shortening (mwSF) is thought to be a more accurate measure of myocardial performance in the presence of left ventricular hypertrophy (LVH). We examined mwSF in pediatric patients with varying degrees of chronic kidney disease (CKD).

Study design

Fifty-seven children with CKD stages 2 to 4, 25 who were undergoin hemodialysis and 49 who were transplant recipients, were compared with 35 healthy control subjects. Left ventricular (LV) geometry and indices of LV function were assessed echocardiographically.

Results

There were no significant differences in LV contractility or endocardial shortening fraction between patients and control subjects. Yet, patients undergoing hemodialysis had significantly lower mwSF compared with control subjects (P < .01) and patients with stage 2 to 4 CKD (P < .01). Renal transplant patients had lower mwSF compared with control subjects (P < .01). The prevalence of abnormal mwSF (ie, <16) was significantly higher in patients undergoing hemodialysis (40%) compared with patients who were renal transplant recipeints (12%) and patients with CKD stages 2 to 4 (9%; P = .03). With stepwise regression, mwSF was demonstrated to be predicted by using relative wall thickness (P < .0001), dialysis group (P = .005), and endocardial shortening fraction (P = .001; model R² = 0.86).

Conclusions

Children undergoing maintenance hemodialysis and children with concentric LVH have subclinical systolic dysfunction, which might be an indicator for the development of more severe cardiac disease.

Abbreviations: ACEI, Angiotensin-converting enzyme inhibitors, ARB, Angiotensin receptor blockers, BB, Beta-blockers, CCB, Calcium channel blockers, CKD, Chronic kidney disease, DBP, Diastolic blood pressure, eSF, Endocardial shortening fraction, GFR, Glomerular filtration rate, LV, Left ventricular, LVH, Left ventricular hypertrophy, LVM, Left ventricular mass, mwSF, Midwall shortening, SBP, Systolic blood pressure, SF, Shortening fraction, VCF, Velocity of circumferential fiber shortening, WS, Wall stress