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

  • Rawan K. Rumman
  • Ronand Ramroop
  • Rahul Chanchlani
  • Mikaeel Ghany
  • Diane Hebert
  • Elizabeth A. Harvey
  • Rulan S. Parekh
  • Luc Mertens
  • Michael Grattan
Original Article

DOI: 10.1007/s00467-017-3622-7

Cite this article as:
Rumman, R.K., Ramroop, R., Chanchlani, R. et al. Pediatr Nephrol (2017). doi:10.1007/s00467-017-3622-7

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.

Keywords

Chronic kidney disease Dialysis Kidney transplant Myocardial mechanics Systolic strain Children 

Supplementary material

467_2017_3622_MOESM1_ESM.doc (48 kb)
Supplementary Table 1(DOC 48 kb)
467_2017_3622_MOESM2_ESM.doc (72 kb)
Supplementary Table 2(DOC 71 kb)

Copyright information

© IPNA 2017

Authors and Affiliations

  • Rawan K. Rumman
    • 1
    • 2
  • Ronand Ramroop
    • 3
  • Rahul Chanchlani
    • 2
    • 4
    • 5
  • Mikaeel Ghany
    • 2
  • Diane Hebert
    • 6
  • Elizabeth A. Harvey
    • 6
  • Rulan S. Parekh
    • 6
    • 7
  • Luc Mertens
    • 3
    • 7
  • Michael Grattan
    • 3
    • 8
  1. 1.Institute of Medical Science, and the Cardiovascular Sciences Collaborative ProgramUniversity of TorontoTorontoCanada
  2. 2.Child Health Evaluative Sciences, Research InstituteThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Division of Cardiology, Labatt Family Heart CenterThe Hospital for Sick ChildrenTorontoCanada
  4. 4.Division of Nephrology, Department of PediatricsMcMaster Children’s Hospital–McMaster UniversityHamiltonCanada
  5. 5.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Division of NephrologyThe Hospital for Sick Children–University of TorontoTorontoCanada
  7. 7.Department of Pediatrics, Hospital for Sick Children and MedicineUniversity Health Network–University of TorontoTorontoCanada
  8. 8.Department of Pediatrics, Children’s Hospital, London Health Sciences Centre University of Western OntarioLondonCanada