Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bock JS, Gottlieb SS (2010) Cardiorenal syndrome: new perspectives. Circulation 121:2592–2600

    Article  PubMed  Google Scholar 

  2. Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Stancanelli B, Cataliotti A, Malatino LS (2004) Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int 65:1492–1498

    Article  PubMed  Google Scholar 

  3. Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE (1998) Long-term evolution of cardiomyopathy in dialysis patients. Kidney Int 54:1720–1725

    Article  PubMed  CAS  Google Scholar 

  4. Siedlecki A, Foushee M, Curtis JJ, Gaston RS, Perry G, Iskandrian AE, de Mattos AM (2007) The impact of left ventricular systolic dysfunction on survival after renal transplantation. Transplantation 84:1610–1617

    Article  PubMed  Google Scholar 

  5. Stack AG, Bloembergen WE (2001) Study of the prevalence and clinical correlates of congestive heart failure among incident US dialysis patients. Am J Kidney Dis 38:992–1000

    Article  PubMed  CAS  Google Scholar 

  6. Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Cataliotti A, Seminara G, Stancanelli B, Malatino LS (2000) Prognostic value of echocardiographic indicators of left ventricular systolic function in asymptomatic dialysis patients. J Am Soc Nephrol 15:1029–1037

    Article  Google Scholar 

  7. Zoccali C, Benedetto FA, Tripepi G, Mallamaci F, Rapisarda F, Seminara G, Bonanno G, Malatino LS (2006) Left ventricular systolic function monitoring in asymptomatic dialysis patients: a prospective cohort study. J Am Soc Nephrol 17:1460–1465

    Article  PubMed  Google Scholar 

  8. Mitsnefes MM, Daniels SR, Schwartz SM, Khoury P, Meyer RA, Strife CF (2000) Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr Nephrol 14:898–902

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. Mitsnefes MM, Kimball TR, Border WL, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Impaired left ventricular diastolic function in children with chronic renal failure. Kidney Int 65:1461–1466

    Article  PubMed  Google Scholar 

  11. Mitsnefes MM, Kimball TR, Border WL, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Abnormal cardiac function in children after renal transplantation. Am J Kidney Dis 43:721–726

    Article  PubMed  Google Scholar 

  12. Palcoux JB, Palcoux MC, Jonan JM, Gourgand JM, Cassagnes J, Malpuech G (1982) Echocardiographic patterns in infants and children with chronic renal failure. Int J Pediatr Nephrol 3:311–314

    PubMed  CAS  Google Scholar 

  13. Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR (1996) Left ventricular abnormalities in children, adolescents, and young adults with renal disease. Kidney Int 50:998–1006

    Article  PubMed  CAS  Google Scholar 

  14. Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2003) Left ventricular mass and systolic performance in pediatric patients with chronic renal failure. Circulation 107:864–868

    Article  PubMed  Google Scholar 

  15. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  16. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  PubMed  Google Scholar 

  17. Pöge U, Gerhardt T, Palmedo H, Klehr HU, Sauerbruch T, Woitas RP (2005) MDRD equations for estimation of GFR in renal transplant recipients. Am J Transplant 5:1306–1311

    Article  PubMed  Google Scholar 

  18. Osman NF, Kerwin WS, McVeigh ER, Prince JL (1999) Cardiac motion tracking using CINE harmonic phase (HARP) magnetic resonance imaging. Magn Reson Med 42:1048–1060

    Article  PubMed  CAS  Google Scholar 

  19. Sarikouch S, Peters B, Gutberlet MB, Leismann B, Kelter-Kloepping A, Koerperich H, Kuehne T, Beerbaum P (2010) Sex-specific pediatric percentiles for ventricular size and mass as reference values for Cardiac MRI: assessment by steady-state free-precession and phase-contrast for MRI flow. Circ Cardiovasc Imaging 3:65–76

    Article  PubMed  Google Scholar 

  20. Hor KN, Wansapura J, Markham LW, Mazur W, Cripe LH, Fleck R, Benson DW, Gottliebson WM (2009) Circumferential strain analysis identifies strata of cardiomyopathy in Duchenne muscular dystrophy: a cardiac magnetic resonance tagging study. J Am Coll Cardiol 53:1204–1210

    Article  PubMed  Google Scholar 

  21. Shivu GN, Abozguia K, Phan TT, Ahmed I, Henning A, Frenneaux M (2008) (31)P magnetic resonance spectroscopy to measure in vivo cardiac energetics in normal myocardium and hypertrophic cardiomyopathy: experiences at 3T. Eur J Radiol 73:255–259

    Article  PubMed  Google Scholar 

  22. Vanhamme L, Sundin T, Hecke PV, Huffel SV (2001) MR spectroscopy quantitation: a review of time-domain methods. NMR Biomed 14:233–246

    Article  PubMed  CAS  Google Scholar 

  23. Beer M, Seyfarth T, Sandstede J, Landschutz W, Lipke C, Kostler H, von Kienlin M, Harre K, Hahn D, Neubauer S (2002) Absolute concentrations of high-energy phosphate metabolites in normal, hypertrophied, and failing human myocardium measured noninvasively with (31)P-SLOOP magnetic resonance spectroscopy. J Am Coll Cardiol 40:1267–1274

    Article  PubMed  CAS  Google Scholar 

  24. Wansapura JP, Hor KN, Mazur W, Fleck R, Hagenbuch S, Benson DW, Gottliebson WM (2010) Left ventricular T2 distribution in Duchenne muscular dystrophy. J Cardiovasc Magn Reson 8:12–14

    Google Scholar 

  25. Beer M (2004) Cardiac spectroscopy: techniques, indications and clinical results. Eur Radiol 14:1034–1047

    Article  PubMed  Google Scholar 

  26. Ogimoto G, Sakurada T, Imamura K, Kuboshima S, Maeba T, Kimura K, Owada S (2003) Alteration of energy production by the heart in CRF patients undergoing peritoneal dialysis. Mol Cell Biochem 244:135–138

    Article  PubMed  CAS  Google Scholar 

  27. Jung WF, Sieverding L, Breuer J, Hoess T, Widmaier S, Schmidt O, Bunse M, van Erckelens F, Apitz J, Lutz O, Dietze GD (1998) 31P NMR spectroscopy detects metabolic abnormalities in asymptomatic patients with hypertrophic cardiomyopathy. Circulation 97:2536–2542

    PubMed  CAS  Google Scholar 

  28. Ridgway JP (2010) Cardiovascular magnetic resonance physics for clinicians: part I. J Cardiovasc Magn Reson 12:71

    Article  PubMed  Google Scholar 

  29. O’Connor RD, Bashir A, Todd Cade W, Yarasheski KE, Gropler RJ (2009) 1H-magnetic resonance spectroscopy for quantifying myocardial lipid content in humans with the cardiometabolic syndrome. J Clin Hypertens 11:528–532

    Article  Google Scholar 

  30. Goldstein SL, Currier H, Watters L, Hempe JM, Sheth RD, Silverstein D (2003) Acute and chronic inflammation in pediatric patients receiving hemodialysis. J Pediatr 143:653–657

    Article  PubMed  CAS  Google Scholar 

  31. Urheim S, Edvardsen T, Torp H, Angelsen B, Smiseth OA (2000) Myocardial strain by Doppler echocardiography. Validation of a new method to quantify regional myocardial function. Circulation 102:1158–1164

    PubMed  CAS  Google Scholar 

  32. Moore CC, McVeigh ER, Zerhouni EA (2000) Quantitative tagged magnetic resonance imaging of the normal human left ventricle. Top Magn Reson Imaging 11:359–371

    Article  PubMed  CAS  Google Scholar 

  33. Parekh RS, Carroll CE, Wolfe RA, Port FK (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197

    Article  PubMed  CAS  Google Scholar 

  34. Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van de Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629

    Article  PubMed  Google Scholar 

  35. McDonald SP, Craig JC, Australian and New Zealand Pediatric Nephrology Association, (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662

    Article  PubMed  CAS  Google Scholar 

  36. Green D, Roberts PR, New DI, Kalra PA (2011) Sudden cardiac death in hemodialysis patients: an in-depth review. Am J Kidney Dis 57:921–929

    Article  PubMed  Google Scholar 

  37. Parekh RS, Plantinga LC, Kao WH, Meoni LA, Jaar BG, Fink NE, Powe NR, Coresh J, Klag MJ (2008) The association of sudden cardiac death with inflammation and other traditional risk factors. Kidney Int 74:1335–1342

    Article  PubMed  CAS  Google Scholar 

  38. Wang AY, Lam CW, Chan IH, Wang M, Lui SF, Sanderson JE (2010) Sudden cardiac death in end-stage renal disease patients: a 5-year prospective analysis. Hypertension 56:210–216

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study was partially presented at 2011 Pediatric Academic Society/ Society for Pediatric Research Meeting, Denver, CO, USA

Funding sources

This study was funded by the research grant DK090070 from the National Institute of Diabetes and Digestive and Kidney Diseases and USPHS Grant #UL1 RR026314 from the National Center for Research Resources, NIH (M.M.M)

Disclosure

The authors do not have any information to disclose.

Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 7022, Cincinnati, OH, 45229, USA

    Rossana Malatesta-Muncher & Mark Mitsnefes

  2. Division of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Janaka Wansapura & Diana Lindquist

  3. Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Michael Taylor & Kan Hor

Authors
  1. Rossana Malatesta-Muncher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janaka Wansapura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diana Lindquist
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kan Hor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark Mitsnefes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Mitsnefes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Malatesta-Muncher, R., Wansapura, J., Taylor, M. et al. Early cardiac dysfunction in pediatric patients on maintenance dialysis and post kidney transplant. Pediatr Nephrol 27, 1157–1164 (2012). https://doi.org/10.1007/s00467-012-2124-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-012-2124-x

Keywords

Search

Navigation