Longitudinal Assessment of Myocardial Function in Childhood Chronic Kidney Disease, During Dialysis, and Following Kidney Transplantation

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2017 Mar 10

PMID 28275864

Citations 16

Authors

Rawan K Rumman

Ronand Ramroop

Rahul Chanchlani

Mikaeel Ghany

Diane Hebert

Elizabeth A Harvey

Rulan S Parekh

Luc Mertens

Michael Grattan

Affiliations

Soon will be listed here.

Abstract

Background: Childhood chronic kidney disease (CKD) and dialysis are associated with increased long-term cardiovascular risk. We examined subclinical alterations in myocardial mechanics longitudinally in children with CKD, during dialysis, and following renal transplantation.

Methods: Forty-eight children with CKD (stage III or higher) who received kidney transplants from 2008 to 2014 were included in a retrospective study and compared to 192 age- and sex-matched healthy children. Measurements of cardiac systolic and diastolic function were performed, and global longitudinal strain (GLS) and circumferential strain (GCS) were measured by speckle-tracking echocardiography at CKD, during dialysis, and 1 year following kidney transplantation. Mixed-effects modeling examined changes in GLS and GCS over different disease stages.

Results: Children with CKD had a mean age of 10 ± 5 years and 67% were male. Eighteen children received preemptive transplantation. Children with CKD had increased left ventricular mass, lower GLS, and impaired diastolic function (lower E/A ratio and E' velocities) than healthy children. Changes in left ventricular diastolic parameters persisted during dialysis and after renal transplantation. Dialysis was associated with reduced GLS compared to CKD (β = 1.6, 95% confidence interval 0.2-3.0); however, this was not significant after adjustment for systolic blood pressure and CKD duration. Post-transplantation GLS levels were similar to those at CKD assessment. GCS was unchanged during dialysis but significantly improved following transplantation.

Conclusions: There are differences in diastolic parameters in childhood CKD that persist during dialysis and after transplantation. Systolic parameters are preserved, with significant improvement in systolic myocardial deformation following transplantation. The impact of persistent diastolic changes on long-term outcomes requires further investigation.

Citing Articles

Hypertension and Left Ventricular Strain in Pediatric Chronic Kidney Disease.

Kula A, Xu Y, Hill G, Furth S, Warady B, Ng D Hypertension. 2024; 81(10):2181-2188.

PMID: 39193718 PMC: 11485407. DOI: 10.1161/HYPERTENSIONAHA.124.23167.

Evaluation of the effect of kidney transplantation on left ventricular myocardial work by noninvasive pressure-strain loops.

Han Z, Wang L, Wang H, He H, Song Y, Wang M Front Cardiovasc Med. 2024; 11:1370307.

PMID: 39119188 PMC: 11306143. DOI: 10.3389/fcvm.2024.1370307.

Changes in Cardiac Structure and Function of Recipients after Kidney Transplantation.

Akkaya S, Cakmak U J Clin Med. 2024; 13(12).

PMID: 38930157 PMC: 11204455. DOI: 10.3390/jcm13123629.

Physical activity and its impact on cardiovascular health in pediatric kidney transplant recipients.

Kohlmeier L, von der Born J, Lehmann E, Frode K, Grabitz C, Greiner A Pediatr Nephrol. 2023; 39(5):1587-1598.

PMID: 38103064 PMC: 10943152. DOI: 10.1007/s00467-023-06248-7.

Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography.

Ladanyi Z, Barczi A, Fabian A, Ujvari A, Cseprekal O, Kis E Front Cardiovasc Med. 2023; 10:1094765.

PMID: 37008334 PMC: 10063872. DOI: 10.3389/fcvm.2023.1094765.

References

Chen R, Wu X, Shen L, Wang B, Ma M, Yang Y . Left ventricular myocardial function in hemodialysis and nondialysis uremia patients: a three-dimensional speckle-tracking echocardiography study. PLoS One. 2014; 9(6):e100265. PMC: 4069011. DOI: 10.1371/journal.pone.0100265. View

Asp A, Wallquist C, Rickenlund A, Hylander B, Jacobson S, Caidahl K . Cardiac remodelling and functional alterations in mild-to-moderate renal dysfunction: comparison with healthy subjects. Clin Physiol Funct Imaging. 2014; 35(3):223-30. PMC: 4405083. DOI: 10.1111/cpf.12154. View

Panoulas V, Sulemane S, Konstantinou K, Bratsas A, Elliott S, Dawson D . Early detection of subclinical left ventricular myocardial dysfunction in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging. 2014; 16(5):539-48. DOI: 10.1093/ehjci/jeu229. View

Mitsnefes M, Kimball T, Border W, Witt S, Glascock B, Khoury P . Abnormal cardiac function in children after renal transplantation. Am J Kidney Dis. 2004; 43(4):721-6. DOI: 10.1053/j.ajkd.2003.12.033. View

Chinali M, de Simone G, Matteucci M, Picca S, Mastrostefano A, Anarat A . Reduced systolic myocardial function in children with chronic renal insufficiency. J Am Soc Nephrol. 2007; 18(2):593-8. DOI: 10.1681/ASN.2006070691. View

Lal A, de Biasi A, Alexander S, Rosenthal D, Sutherland S . End-stage renal disease and cardiomyopathy in children: cardiac effects of renal transplantation. Transplantation. 2011; 93(2):182-7. DOI: 10.1097/TP.0b013e31823be7f8. View

Krishnasamy R, Isbel N, Hawley C, Pascoe E, Leano R, Haluska B . The association between left ventricular global longitudinal strain, renal impairment and all-cause mortality. Nephrol Dial Transplant. 2014; 29(6):1218-25. DOI: 10.1093/ndt/gfu004. View

Koopman L, McCrindle B, Slorach C, Chahal N, Hui W, Sarkola T . Interaction between myocardial and vascular changes in obese children: a pilot study. J Am Soc Echocardiogr. 2012; 25(4):401-410.e1. DOI: 10.1016/j.echo.2011.12.018. View

Mitsnefes M . Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol. 2012; 23(4):578-85. PMC: 3312513. DOI: 10.1681/ASN.2011111115. View

10.

Kim G, Kwon B, Kang H, Ha J, Ha I, Noh C . Cardiac dysfunction after renal transplantation; incomplete resolution in pediatric population. Transplantation. 2009; 87(11):1737-43. DOI: 10.1097/TP.0b013e3181a63f2f. View

11.

Fukushima K, Javadi M, Higuchi T, Bravo P, Chien D, Lautamaki R . Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease: a quantitative analysis of clinical 82Rb PET/CT studies. J Nucl Med. 2012; 53(6):887-93. DOI: 10.2967/jnumed.111.099325. View

12.

Mignot A, Donal E, Zaroui A, Reant P, Salem A, Hamon C . Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. J Am Soc Echocardiogr. 2010; 23(10):1019-24. DOI: 10.1016/j.echo.2010.07.019. View

13.

Hayashi S, Rohani M, Lindholm B, Brodin L, Lind B, Barany P . Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2005; 21(1):125-32. DOI: 10.1093/ndt/gfi075. View

14.

Falkner B, Daniels S . Summary of the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Hypertension. 2004; 44(4):387-8. DOI: 10.1161/01.HYP.0000143545.54637.af. View

15.

Simpson J, Rawlins D, Mathur S, Chubb H, Sinha M . Systolic and diastolic ventricular function assessed by tissue Doppler imaging in children with chronic kidney disease. Echocardiography. 2012; 30(3):331-7. DOI: 10.1111/echo.12015. View

16.

Dounousi E, Mitsis M, Naka K, Pappas C, Lakkas L, Harisis C . Differences in cardiac structure assessed by echocardiography between renal transplant recipients and chronic kidney disease patients. Transplant Proc. 2014; 46(9):3194-8. DOI: 10.1016/j.transproceed.2014.10.034. View

17.

Friedberg M, Mertens L . Deformation imaging in selected congenital heart disease: is it evolving to clinical use?. J Am Soc Echocardiogr. 2012; 25(9):919-31. DOI: 10.1016/j.echo.2012.06.008. View

18.

Shamszad P, Slesnick T, OBrian Smith E, Taylor M, Feig D . Association between left ventricular mass index and cardiac function in pediatric dialysis patients. Pediatr Nephrol. 2011; 27(5):835-41. DOI: 10.1007/s00467-011-2060-1. View

19.

Lindblad Y, Axelsson J, Balzano R, Vavilis G, Chromek M, Celsi G . Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease. Pediatr Nephrol. 2013; 28(10):2003-13. DOI: 10.1007/s00467-013-2504-x. View

20.

Mencarelli F, Fabi M, Corazzi V, Doyon A, Masetti R, Bonetti S . Left ventricular mass and cardiac function in a population of children with chronic kidney disease. Pediatr Nephrol. 2013; 29(5):893-900. DOI: 10.1007/s00467-013-2710-6. View