Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease
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Myocardial dysfunction is common in chronic kidney disease (CKD) and related to poor outcomes. New non-invasive methods to assess cardiac function have been introduced, but comparative studies evaluating their clinical usefulness in pediatric CKD are lacking. We studied left ventricular (LV) function in pediatric CKD and renal transplant patients, comparing conventional pulse-wave Doppler echocardiography (cPWD) with newer tissue Doppler imaging (TDI) and relating the results to known cardiovascular risk factors.
The study included 34 children/adolescents with CKD stages 2–5, 44 renal transplant patients and 19 patients with a normal renal function. The mean age was 11.4 (range 0.8–18.8) years.
Both patient groups had significantly lower LV diastolic function than those with a normal renal function. The most sensitive determinants were TDI E′/A′ and cPWD E/TDI E′ ratios. In a stepwise linear regression analysis, high blood pressure, young age and the presence of albuminuria all independently predicted LV diastolic function.
Our study confirms the high prevalence of LV diastolic dysfunction in pediatric CKD patients and following renal transplantation, where TDI appears to be more sensitive than cPWD in assessing early myocardial dysfunction. Our results also underline the importance of preventive measures, such as rigorous blood pressure control, in pediatric CKD.
KeywordsPediatric CKD Renal transplant TDI cPWD Myocardial dysfunction
Ylva Tranæus Lindblad was partly supported by grants from the Swedish Kidney Foundation, as well as those from the Jerring-, Freemason-, Swärd/Ekelund-, Samaritan- and Signe Olof Wallenius- Foundations. Financial support was also provided by the Society of child-welfare and through the regional agreement on medical training and clinical research (ALF) between Stockholm county council and the Karolinska Institute. The authors also wish to thank the nurses and staff at the Pediatric Nephrology Department at Astrid Lindgren Pediatric Hospital Huddinge, as well as the staff at the renal research lab. Special thanks is given to Abdul Rashid Qureshi who checked and reanalyzed the multiple regression statistical analyses.
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