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Kidney transplantation in children with decreased left ventricular systolic function: a Midwest Pediatric Nephrology Consortium study

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Abstract

Background

Left ventricular (LV) systolic dysfunction is a relatively uncommon but serious complication of pediatric chronic kidney disease, and may be related to uremia and uncontrolled hypertension. There is limited information on the strategy for managing these children. In some cases, combined heart–kidney transplant may be considered or kidney transplant delayed until cardiac function improves. It is unknown whether these patients are at increased risk for poor outcomes after kidney transplantation.

Methods

We conducted a retrospective, multicenter study on the outcomes of children with severe and symptomatic cardiomyopathy who underwent kidney transplantation.

Results

Eleven patients receiving maintenance dialysis with systolic dysfunction underwent kidney transplantation without simultaneous heart transplant. Nine patients had congestive heart failure in the pre-transplant period. There were no identified complications post-transplant related to the underlying cardiac dysfunction. LV systolic function normalized in all patients and the mean shortening fraction increased from 19.0 ± 4.6 % to 32.0 ± 4.4 % (p < 0.0001).

Conclusions

Kidney transplantation should be considered for children receiving maintenance dialysis with severe LV dysfunction.

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Abbreviations

CKD:

Chronic kidney disease

EF:

Ejection fraction

ESRD:

End-stage renal disease

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVH:

Left ventricular hypertrophy

LVSF:

Left ventricular shortening fraction

References

  1. 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  CAS  PubMed  Google Scholar 

  2. Becker-Cohen R, Nir A, Ben-Shalom E, Rinat C, Feinstein S, Farber B, Frishberg Y (2008) Improved left ventricular mass index in children after renal transplantation. Pediatr Nephrol 23:1545–1550

    Article  PubMed  Google Scholar 

  3. Ulinski T, Genty J, Viau C, Tillous-Borde I, Deschenes G (2006) Reduction of left ventricular hypertrophy in children undergoing hemodialysis. Pediatr Nephrol 21:1171–1178

    Article  PubMed  Google Scholar 

  4. Goren A, Glaser J, Drukker A (1993) Diastolic function in children and adolescents on dialysis and after kidney transplantation: an echocardiographic assessment. Pediatr Nephrol 7:725–728

    Article  CAS  PubMed  Google Scholar 

  5. Weaver DJ Jr, Kimball T, Witt SA, Glascock BJ, Khoury PR, Kartal J, Mitsnefes MM (2008) Subclinical systolic dysfunction in pediatric patients with chronic kidney disease. J Pediatr 153:565–569

    Article  PubMed  Google Scholar 

  6. 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 

  7. Chavers BM, Solid CA, Sinaiko A, Daniels FX, Chen SC, Collins AJ, Frankenfield DL, Herzog CA (2011) Diagnosis of cardiac disease in pediatric end-stage renal disease. Nephrol Dial Transplant 26:1640–1645

    Article  PubMed Central  PubMed  Google Scholar 

  8. Rinat C, Becker-Cohen R, Nir A, Feinstein S, Shemesh D, Algur N, Ben Shalom E, Farber B, Frishberg Y (2010) A comprehensive study of cardiovascular risk factors, cardiac function and vascular disease in children with chronic renal failure. Nephrol Dial Transplant 25:785–793

    Article  PubMed  Google Scholar 

  9. O’Regan S, Matina D, Ducharme G, Davignon A (1983) Echocardiographic assessment of cardiac function in children with chronic renal failure. Kidney Int Suppl 15:S77–S82

    PubMed  Google Scholar 

  10. Vanholder R, Glorieux G, Lameire N, European Uremic Toxin Work Group (2003) Uraemic toxins and cardiovascular disease. Nephrol Dial Transplant 18:463–466

    Article  CAS  PubMed  Google Scholar 

  11. Mann JF, Jakobs KH, Riedel J, Ritz E (1986) Reduced chronotropic responsiveness of the heart in experimental uremia. Am J Physiol 250:H846–H852

    CAS  PubMed  Google Scholar 

  12. Dhein S, Rohnert P, Markau S, Kotchi-Kotchi E, Becker K, Poller U, Osten B, Brodde OE (2000) Cardiac beta-adrenoceptors in chronic uremia: studies in humans and rats. J Am Coll Cardiol 36:608–617

    Article  CAS  PubMed  Google Scholar 

  13. Mall G, Huther W, Schneider J, Lundin P, Ritz E (1990) Diffuse intermyocardiocytic fibrosis in uraemic patients. Nephrol Dial Transplant 5:39–44

    Article  CAS  PubMed  Google Scholar 

  14. Converse RL Jr, Jacobsen TN, Toto RD, Jost CM, Cosentino F, Fouad-Tarazi F, Victor RG (1992) Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 327:1912–1918

    Article  PubMed  Google Scholar 

  15. Brecht HM, Ernst W, Koch KM (1976) Plasma noradrenaline levels in regular haemodialysis patients. Proc Eur Dial Transplant Assoc 12:281–290

    CAS  PubMed  Google Scholar 

  16. Movahed A, Reeves WC, Mehta PM, Gilliland MG, Mozingo SL, Jolly SR (1994) Norepinephrine-induced left ventricular dysfunction in anesthetized and conscious, sedated dogs. Int J Cardiol 45:23–33

    Article  CAS  PubMed  Google Scholar 

  17. North American Pediatric Renal Trials and Collaborative Studies (2010) NAPRTCS 2010 Annual Transplant Report. Available from https://web.emmes.com/study/ped/annlrept/2010_Report.pdf

  18. Burt RK, Gupta-Burt S, Suki WN, Barcenas CG, Ferguson JJ, Van Buren CT (1989) Reversal of left ventricular dysfunction after renal transplantation. Ann Intern Med 111:635–640

    Article  CAS  PubMed  Google Scholar 

  19. Wali RK, Wang GS, Gottlieb SS, Bellumkonda L, Hansalia R, Ramos E, Drachenberg C, Papadimitriou J, Brisco MA, Blahut S, Fink JC, Fisher ML, Bartlett ST, Weir MR (2005) Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease. J Am Coll Cardiol 45:1051–1060

    Article  PubMed  Google Scholar 

  20. Palmeri ST, Cohen L, Shindler DM (2011) Chapter 1. Echocardiography. In: Pahlm O, Wagner GS (eds) Multimodal Cardiovascular Imaging: Principles and Clinical Applications. The McGraw-Hill Companies, New York, NY, p 15

    Google Scholar 

  21. Schwartz GJ, Munoz 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 Central  PubMed  Google Scholar 

  22. Sahagun-Sanchez G, Espinola-Zavaleta N, Lafragua-Contreras M, Chavez PY, Gomez-Nunez N, Keirns C, Romero-Cardenas A, Perez-Grovas H, Acosta JH, Vargas-Barron J (2001) The effect of kidney transplant on cardiac function: an echocardiographic perspective. Echocardiography 18:457–462

    Article  CAS  PubMed  Google Scholar 

  23. Nakajima K, Ochiai T, Suzuki T, Gunji Y, Asano T, Isono K, Mikami Y, Sakamoto K, Kashiwabara H, Yamada K (1998) Beneficial effects of renal transplantation on cardiovascular disorders in dialysis patients. Surg Today 28:811–815

    Article  CAS  PubMed  Google Scholar 

  24. Alvares S, Mota C, Soares L, Henriques C, Pereira E, Sarmento AM, Lima CA (1998) Cardiac consequences of renal transplantation changes in left ventricular morphology. Rev Port Cardiol 17:145–152

    CAS  PubMed  Google Scholar 

  25. Melchor JL, Espinoza R, Gracida C (2002) Kidney transplantation in patients with ventricular ejection fraction less than 50 percent: features and posttransplant outcome. Transplant Proc 34:2539–2540

    Article  CAS  PubMed  Google Scholar 

  26. Ferreira SR, Moises VA, Tavares A, Pacheco-Silva A (2002) Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation 74:1580–1587

    Article  PubMed  Google Scholar 

  27. Lal AK, de Biasi AR, Alexander S, Rosenthal DN, Sutherland SM (2012) End-stage renal disease and cardiomyopathy in children: cardiac effects of renal transplantation. Transplantation 93:182–187

    Article  PubMed  Google Scholar 

  28. Parfrey PS, Harnett JD, Foley RN, Kent GM, Murray DC, Barre PE, Guttmann RD (1995) Impact of renal transplantation on uremic cardiomyopathy. Transplantation 60:908–914

    Article  CAS  PubMed  Google Scholar 

  29. Josephson CB, Delgado D, Schiff J, Ross H (2008) The effectiveness of renal transplantation as a treatment for recurrent uremic cardiomyopathy. Can J Cardiol 24:315–317

    Article  PubMed Central  PubMed  Google Scholar 

  30. Nehus E, Goebel J, Mitsnefes M, Lorts A, Laskin B (2011) Intensive hemodialysis for cardiomyopathy associated with end-stage renal disease. Pediatr Nephrol 26:1909–1912

    Article  PubMed  Google Scholar 

  31. Adhyapak SM, Iyengar SS (2011) Characteristics of a subset of patients with reversible systolic dysfunction in chronic kidney disease. Congest Heart Fail 17:120–126

    Article  CAS  PubMed  Google Scholar 

  32. Alhaj E, Alhaj N, Rahman I, Niazi TO, Berkowitz R, Klapholz M (2013) Uremic cardiomyopathy: an underdiagnosed disease. Congest Heart Fail 19:E40–E45

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Dr. Ritu Sachdeva, MD, for her help with echocardiogram data.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, University of Kansas Medical Center, Kansas City, KS, USA

    Sandeep K. Riar

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

    Mark M. Mitsnefes & Edward J. Nehus

  3. Division of Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA

    Hiren P. Patel

  4. Division of Pediatric Nephrology, Dialysis and Transplantation, Helen Devos Children’s Hospital and Clinics, Grand Rapids, MI, USA

    Julia M. Steinke & Teri Crumb

  5. Division of Nephrology, SSM Cardinal Glennon Children’s Medical Center, St. Louis, MO, USA

    Elizabeth C. Abraham

  6. Division of Pediatric Nephrology, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Margret W. Kamel & Larry A. Greenbaum

Authors
  1. Sandeep K. Riar
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  2. Mark M. Mitsnefes
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  3. Edward J. Nehus
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  4. Hiren P. Patel
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  5. Julia M. Steinke
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  6. Teri Crumb
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  7. Elizabeth C. Abraham
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Corresponding author

Correspondence to Sandeep K. Riar.

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Riar, S.K., Mitsnefes, M.M., Nehus, E.J. et al. Kidney transplantation in children with decreased left ventricular systolic function: a Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 30, 1343–1348 (2015). https://doi.org/10.1007/s00467-015-3066-x

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  • DOI: https://doi.org/10.1007/s00467-015-3066-x

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