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Pediatric Nephrology

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10.11.2022 | Original Article

Alterations in diastolic function and cardiac geometry in children: a longitudinal study across the spectrum of dialysis and transplant

verfasst von: Kristen Sgambat, Sarah Clauss, Asha Moudgil

Erschienen in: Pediatric Nephrology | Ausgabe 6/2023

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Abstract

Background

Children with kidney failure have increased risk for cardiovascular morbidities before and after transplantation. Ejection fraction is often preserved, masking cardiac dysfunction until severe. Data on longitudinal changes in diastolic function and cardiac geometry are limited.

Methods

A prospective study was conducted to investigate longitudinal changes in diastolic function and structure pre- and post-kidney transplant compared with healthy peers. Transplant recipients (n = 41) had echocardiograms pre-transplant, 1, 18, 30, and 42 months post-transplant. The controls (n = 26) underwent one echocardiogram. Diastolic function and cardiac geometry were assessed by E/e’ lateral, E/A, interventricular septal end diastole diameter, left ventricular internal end diastole diameter, left ventricular posterior wall end diastole diameter, and left atrial dimension.

Results

E/e’ of patients remained worse than controls until 30 months post-transplant, and E/A was impaired at all time points compared to the controls. Left ventricular geometry was abnormal in 46% pre-transplant and remained altered in 44.7%, 32.3%, 30.7%, and 27.2% at 1, 18, 30, and 42 months post-transplant. Determinants of diastolic dysfunction included hemodialysis, uncontrolled hypertension, steroid exposure, and metabolic syndrome; abnormal geometry was associated with glomerular diagnosis, dialysis duration, obesity, steroids, and metabolic syndrome. Abnormal diastolic function and structure were associated with left ventricular hypertrophy.

Conclusion

Diastolic dysfunction and geometry partially improve after transplant but remain abnormal in a subset of patients compared to healthy peers. Traditional indicators of systolic function are preserved. Modifiable risk factors include dialysis modality and duration, uncontrolled hypertension, corticosteroids, obesity, and metabolic syndrome. Attention to diastolic changes provides opportunity for early intervention.

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Titel: Alterations in diastolic function and cardiac geometry in children: a longitudinal study across the spectrum of dialysis and transplant
verfasst von: Kristen Sgambat
Sarah Clauss
Asha Moudgil
Publikationsdatum: 10.11.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 6/2023
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-022-05771-3

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Springer Medizin

Alterations in diastolic function and cardiac geometry in children: a longitudinal study across the spectrum of dialysis and transplant

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

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Klimaschutz beginnt bei der Wahl des Inhalators

Embryotransfer erhöht womöglich Leukämierisiko der Kinder

Darf man die Behandlung eines Neonazis ablehnen?

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Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

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