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Longitudinal Assessment of Myocardial Function in Childhood Chronic Kidney Disease, During Dialysis, and Following Kidney Transplantation
Pediatric Nephrology
  • Rawan K Rumman, University of Toronto, Toronto
  • Ronand Ramroop, The Hospital for Sick Children
  • Rahul Chanchlani, University of Toronto
  • Mikaeel Ghany, The Hospital for Sick Children
  • Diane Hebert, University of Toronto
  • Elizabeth A Harvey, University of Toronto
  • Rulan S Parekh, University of Toronto
  • Luc Mertens, University of Toronto
  • Michael Grattan, Western University
Document Type
Article
Publication Date
8-1-2017
URL with Digital Object Identifier
https://doi.org/10.1007/s00467-017-3622-7
Disciplines
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.

Citation Information
Rawan K Rumman, Ronand Ramroop, Rahul Chanchlani, Mikaeel Ghany, et al.. "Longitudinal Assessment of Myocardial Function in Childhood Chronic Kidney Disease, During Dialysis, and Following Kidney Transplantation" Pediatric Nephrology Vol. 32 Iss. 8 (2017) p. 1401 - 1410
Available at: http://works.bepress.com/michael-grattan/4/