Early cardiac dysfunction in pediatric patients on maintenance dialysis and post kidney transplant

Rossana Malatesta-Muncher, Janaka Wansapura, Michael Taylor, Diana Lindquist, Kan Hor, Mark Mitsnefes

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31P MRS) to assess markers of cardiac dysfunction in young CKD patients. Methods Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison. Results All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r=-0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02). Conclusion Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy.

Original languageEnglish (US)
Pages (from-to)1157-1164
Number of pages8
JournalPediatric Nephrology
Volume27
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Keywords

  • Cardiac MRI
  • Cardiovascular
  • Children
  • Chronic kidney disease
  • Dialysis
  • Transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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