Pediatric Nephrology

, Volume 27, Issue 7, pp 1157–1164 | Cite as

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
Original Article



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.


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.


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).


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.


Cardiac MRI Children Chronic kidney disease Dialysis Transplant Cardiovascular 


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Copyright information

© IPNA 2012

Authors and Affiliations

  • Rossana Malatesta-Muncher
    • 1
  • Janaka Wansapura
    • 2
  • Michael Taylor
    • 3
  • Diana Lindquist
    • 2
  • Kan Hor
    • 3
  • Mark Mitsnefes
    • 1
  1. 1.Division of Nephrology and HypertensionCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Heart InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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