Cardiac geometry in children receiving chronic peritoneal dialysis: findings from the International Pediatric Peritoneal Dialysis Network (IPPN) registry

Abstract

Background and objectives: Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow-up in dialyzed children.

Design, setting, participants, & measurements: Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95(th) percentile of LV mass index relative to height age was used to define LVH.

Results: The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia.

Conclusions: Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH.

Figure 1.

Evolution of left ventricular geometry in 128 chronic peritoneal dialysis patients with follow-up echocardiogram after 12 ± 4 months. The percentage figures indicate prevalence rates at first and second examination. Straight arrows indicate the numbers of patients changing between categories from first to second examination. Curved arrows indicate the numbers of the patients remaining in the same geometric category. LV, left ventricle; LVH, left ventricle hypertrophy.

Figure 2.

Average systolic BP standard deviation score (SDS) during follow-up in 50 children without left ventricular hypertrophy (LVH), 23 children regressing from LVH to normal left ventricular (LV) mass index, 20 children progressing to LVH, and 35 children with persistent LVH during prospective echocardiographic monitoring. BP is expressed as SDS to account for patient age, height, and gender. The bars are the means ± SEMs. Superscript letters denote significance of between-group differences; groups sharing the same letter do not differ significantly at P < 0.05.