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Multicenter Study
. 2011 Aug;6(8):1934-43.
doi: 10.2215/CJN.11411210. Epub 2011 Jul 7.

Defining left ventricular hypertrophy in children on peritoneal dialysis

Dagmara Borzych  1 , Sevcan A Bakkaloglu, Joshua Zaritsky, Angela Suarez, William Wong, Bruno Ranchin, Cao Qi, Attila J Szabo, Paula A Coccia, Jérôme Harambat, Florin Mitu, Bradley A Warady, Franz Schaefer; International Pediatric Peritoneal Dialysis Network
Affiliations
Multicenter Study

Defining left ventricular hypertrophy in children on peritoneal dialysis

Dagmara Borzych et al. Clin J Am Soc Nephrol. 2011 Aug.

Abstract

Background and objectives: Left ventricular hypertrophy (LVH) is an important end point of dialysis-associated cardiovascular disease. The objective of this study was to evaluate the effect of different pediatric reference systems on the estimated prevalence of LVH in children on chronic peritoneal dialysis (CPD).

Design, setting, participants, & measurements: Echocardiographic studies in 507 pediatric CPD patients from neonatal age to 19 years were collected in 55 pediatric dialysis units around the globe. We compared the prevalence of LVH on the basis of the traditional cutoff of left ventricular mass (LVM) index (>38.5 g/m(2.7)) with three novel definitions of LVH that were recently established in healthy pediatric cohorts.

Results: Application of the new reference systems eliminated the apparently increased prevalence of LVH in young children obtained by the traditional fixed LVM index cutoff currently still recommended by consensus guidelines. However, substantial differences of LVM distribution between the new reference charts resulted in a marked discrepancy in estimated LVH prevalence ranging between 27.4% and 51.7%.

Conclusions: Although our understanding of the anthropometric determinants of heart size during childhood is improving, more consistent normative echocardiographic data from large populations of healthy children are required for cardiovascular diagnostics and research.

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Figures

Figure 1.
Figure 1.
Inverse correlation of left ventricular mass index (LVMI) with body height in 507 children on chronic peritoneal dialysis (CPD).
Figure 2.
Figure 2.
Upper panel: Deviation of height age from chronological age in 507 children on CPD. Lower panel: Effect of reference to height age rather than chronological age on LVMI percentile assignment. At the age of 8 years, the mean height age in the CPD population is 6 years. As a consequence, an 8-year-old child with average growth retardation and LVMI at the 95th percentile for age will be ranked in the 90th LVMI percentile when referring to height age.
Figure 3.
Figure 3.
Upper panel: Distribution of left ventricular mass (LVM) SD score (SDS) using the lambda-mu-sigma (LMS) reference tables of Foster et al. Lines indicate the 5th and 95th percentiles (14). Lower panels: Distribution of LVMI for height age relative to the reference range of Khoury et al. Lines indicate the 10th and 95th percentiles (15).
Figure 4.
Figure 4.
Age-related prevalence of left ventricular hypertrophy (LVH) in 507 children on CPD using different reference systems. LVH criteria were fixed LVMI > 38.6 g/m2.7 (11), 95th LVMI percentile for chronological age according to Khoury et al. (15), 95th LVMI Khoury percentile using height age for reference, and 95th percentile of LVM for height according to Foster et al. (14).
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