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08.03.2017 | Original Article

Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation

verfasst von: Rawan K. Rumman, Ronand Ramroop, Rahul Chanchlani, Mikaeel Ghany, Diane Hebert, Elizabeth A. Harvey, Rulan S. Parekh, Luc Mertens, Michael Grattan

Erschienen in: Pediatric Nephrology | Ausgabe 8/2017

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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.

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Titel: Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation
verfasst von: Rawan K. Rumman
Ronand Ramroop
Rahul Chanchlani
Mikaeel Ghany
Diane Hebert
Elizabeth A. Harvey
Rulan S. Parekh
Luc Mertens
Michael Grattan
Publikationsdatum: 08.03.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 8/2017
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-017-3622-7

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Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation