Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;38(6):1925-1933.
doi: 10.1007/s00467-022-05796-8. Epub 2022 Nov 10.

Left ventricular hypertrophy in pediatric patients on maintenance dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Kyle Merrill  1 , Shirley Galbiati  2 , Mark Mitsnefes  3 ; NAPRTCS Investigators
Affiliations

Left ventricular hypertrophy in pediatric patients on maintenance dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Kyle Merrill et al. Pediatr Nephrol. 2023 Jun.

Abstract

Background: Cardiovascular disease is the leading cause of death in pediatric patients with kidney failure. Left ventricular hypertrophy (LVH) is recognized as the most common cardiovascular abnormality in these patients. There remains a paucity of longitudinal studies evaluating LVH during maintenance dialysis in children. NAPRTCS has collected echocardiographic data of pediatric maintenance dialysis patients since 2013 and is one of the largest registries to assess longitudinal changes in LVH.

Methods: Patients aged 1-18 years with echocardiographic data and without underlying structural cardiovascular diseases were included. LVH was defined as left ventricular mass index (LVMI, height-indexed) > 95th percentile for age and sex. Univariate and multivariable logistic regression was performed to assess risk factors for LVH at baseline. Generalized estimating equation was used to assess risk factors of changes in LVH during maintenance dialysis.

Results: A total of 518 patients had echocardiographic data available for analysis during time on maintenance dialysis. Of 179 patients with baseline echocardiography (within 30 days of dialysis initiation), 67% had LVH. In multivariable logistic regression adjusted for age, race, and sex, uncontrolled hypertension (OR 9.4, 95% CI 2.8-31) and anemia (OR 2.3, 95% CI 1.0-5.3) were associated with LVH at baseline. Prevalence of LVH remained high at 40-50% during follow-up. Controlled and uncontrolled hypertension as well as phosphorus level were independently associated with increased likelihood of LVH during maintenance dialysis.

Conclusions: LVH is prevalent in pediatric patients at dialysis initiation and remains prevalent during follow-up. Hypertension is the strongest risk factor for LVH in children on maintenance dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Cardiovascular; Children; Dialysis; Hypertension; Kidney failure; Left ventricular hypertrophy.

PubMed Disclaimer

References

    1. Mitsnefes MM, Daniels SR, Schwartz SM, Meyer RA, Khoury P, Strife CF (2000) Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr Nephrol 14:898–902. https://doi.org/10.1007/s004670000303 - DOI - PubMed
    1. Bakkaloglu SA, Borzych D, Soo Ha I, Serdaroglu E, Büscher R, Salas P, Patel H, Drozdz D, Vondrak K, Watanabe A, Villagra J, Yavascan O, Valenzuela M, Gipson D, Ng KH, Warady BA, Schaefer F, International Pediatric Peritoneal Dialysis Network (2011) Cardiac geometry in children receiving chronic peritoneal dialysis: findings from the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Clin J Am Soc Nephrol 6:1926–1933. https://doi.org/10.2215/CJN.05990710 - DOI - PubMed - PMC
    1. Melhem N, Savis A, Wheatley A, Copeman H, Willmott K, Reid CJD, Simpson J, Sinha MD (2019) Improved blood pressure and left ventricular remodelling in children on chronic intermittent haemodialysis: a longitudinal study. Pediatr Nephrol 34:1811–1820. https://doi.org/10.1007/s00467-019-04272-0 - DOI - PubMed
    1. Mitsnefes MM, Barletta GM, Dresner IG, Chand DH, Geary D, Lin JJ, Patel H (2006) Severe cardiac hypertrophy and long-term dialysis: the Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 21:1167–1170. https://doi.org/10.1007/s00467-006-0180-9 - DOI - PubMed
    1. Mitsnefes MM, Daniels SR, Schwartz SM, Khoury P, Strife CF (2001) Changes in left ventricular mass in children and adolescents during chronic dialysis. Pediatr Nephrol 16:318–323. https://doi.org/10.1007/s004670000557 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources