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Reduction of left ventricular hypertrophy in children undergoing hemodialysis

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Abstract

Left ventricular hypertrophy (LVH) is related to a 1,000-fold increased risk of cardiovascular morbidity and mortality in young adults with end-stage renal disease (ESRD) treated with hemodialysis (HD) or peritoneal dialysis. We report a series of 17 children (5 girls, 12 boys), with a median (range) age of 11 (2–18) years, all treated by HD, who presented with an increased left ventricular mass (LVM) index of 54.8±4.5 g/m2.7 at onset of HD and reached 36.2±2.6 g/m2.7 (mean±SEM, P<0.0001) at last follow up. Over the observation period, systolic (P<0.0001) and diastolic (P<0.0001) blood pressure (indexed for height, gender, and age) decreased and hemoglobin (+2.8 g/dL; P<0.0001) increased compared to initial values. Only BP as well as plasma protein level at onset of HD session correlated with LVM in multiple correlation analysis. In conclusion, increased LVM is a common feature in pediatric patients with ESRD. Normalization of BP and reduction of the extracellular volume (represented by plasma protein at onset of HD session) are key points in reducing LVH during HD in children.

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References

  1. Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32:S112–S119

    Article  CAS  Google Scholar 

  2. Paoletti E, Specchia C, Di Maio G, Bellino D, Damasio B, Cassottana P, Cannella G (2004) The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey. Nephrol Dial Transplant 19:1829–1834

    Article  Google Scholar 

  3. London GM, Pannier B, Guerin AP, Blacher J, Marchais SJ, Darne B, Metivier F, Adda H, Safar ME (2001) Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 12:2759–2767

    CAS  PubMed  Google Scholar 

  4. Hampl H, Sternberg C, Berweck S, Lange D, Lorenz F, Pohle C, Riedel E, Gogoll L, Hennig L (2002) Regression of left ventricular hypertrophy in hemodialysis patients is possible. Clin Nephrol 58(Suppl 1):S73–S96

    PubMed  Google Scholar 

  5. Chan CT, Floras JS, Miller JA, Richardson RM, Pierratos A (2002) Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int 61:2235–2239

    Article  Google Scholar 

  6. Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line haemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367

    Article  Google Scholar 

  7. Cannella G, La Canna G, Sandrini M, Gaggiotti M, Nordio G, Movilli E, Mombelloni S, Visioli O, Maiorca R (1991) Reversal of left ventricular hypertrophy following recombinant human erythropoietin treatment of anaemic dialysed uraemic patients. Nephrol Dial Transplant 6:31–37

    Article  CAS  Google Scholar 

  8. Pascual J, Teruel JL, Moya JL, Liano F, Jimenez-Mena M, Ortuno J (1991) Regression of left ventricular hypertrophy after partial correction of anemia with erythropoietin in patients on hemodialysis: a prospective study. Clin Nephrol 35:280–287

    CAS  PubMed  Google Scholar 

  9. London GM, Pannier B, Guerin AP, Marchais SJ, Safar ME, Cuche JL (1994) Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade. Circulation 90:2786–2796

    Article  CAS  Google Scholar 

  10. Paoletti E, Cannella G (2002) Arterial hypertension and left ventricular hypertrophy in hemodialysis patients. Clin Nephrol 58(Suppl 1):S46–S51

    PubMed  Google Scholar 

  11. Ozkahya M, Toz H, Qzerkan F, Duman S, Ok E, Basci A, Mees EJ (2002) Impact of volume control on left ventricular hypertrophy in dialysis patients. J Nephrol 15:655–660

    PubMed  Google Scholar 

  12. Morris KP, Skinner JR, Wren C, Hunter S, Coulthard MG (1993) Cardiac abnormalities in end stage renal failure and anaemia. Arch Dis Child 68:637–643

    Article  CAS  Google Scholar 

  13. Mitsnefes MM (2004) Hypertension and end-organ damage in pediatric renal transplantation. Pediatr Transplant 8:394–399

    Article  Google Scholar 

  14. 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  CAS  Google Scholar 

  15. Robinson RF, Nahata MC, Sparks E, Daniels C, Batisky DL, Hayes JR, Mahan JD (2005) Abnormal left ventricular mass and aortic distensibility in pediatric dialysis patients. Pediatr Nephrol 20:64–68

    Article  Google Scholar 

  16. Bakkaloglu SA, Ekim M, Kocak G, Atalay S, Tumer N (2001) Impact of dialysis adequacy on cardiac function in pediatric CAPD patients. Perit Dial Int 21:395–400

    CAS  PubMed  Google Scholar 

  17. Holtta T, Happonen JM, Ronnholm K, Fyhrquist F, Holmberg C (2001) Hypertension, cardiac state, and the role of volume overload during peritoneal dialysis. Pediatr Nephrol 16:324–331

    Article  CAS  Google Scholar 

  18. 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  Google Scholar 

  19. Mitsnefes MM, Schwartz SM, Daniels SR, Kimball TR, Khoury P, Strife CF (2001) Changes in left ventricular mass index in children and adolescents after renal transplantation. Pediatr Transplant 5:279–284

    Article  CAS  Google Scholar 

  20. 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  Google Scholar 

  21. 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  Google Scholar 

  22. Hattori S, Yosioka K, Honda M, Ito H (2002) The 1998 report of the Japanese National Registry data on pediatric end-stage renal disease patients. Pediatr Nephrol 17:456–461

    Article  Google Scholar 

  23. Chavers B, Schnaper HW (2001) Risk factors for cardiovascular disease in children on maintenance dialysis. Adv Ren Replace Ther 8:180–190

    Article  CAS  Google Scholar 

  24. Parekh RS, Zhang L, Fivush BA, Klag MJ (2005) Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population. J Am Soc Nephrol 16:1420–1426

    Article  Google Scholar 

  25. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105

    Article  Google Scholar 

  26. Gruppen MP, Groothoff JW, Prins M, van der Wouw P, Offringa M, Bos WJ, Davin JC, Heymans HS (2003) Cardiac disease in young adult patients with end-stage renal disease since childhood: a Dutch cohort study. Kidney Int 63:1058–1065

    Article  Google Scholar 

  27. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, Alderman MH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260

    Article  Google Scholar 

  28. Matteucci MC, Wuhl E, Picca S, Mastrostefano A, Rinelli G, Romano C, Rizzoni G, Mehls O, de Simone G, Schaefer F (2006) Left ventricular geometry in children with mild to moderate chronic renal insufficiency. J Am Soc Nephrol 17:218–226

    Article  Google Scholar 

  29. Mitsnefes MM, Daniels SR, Schwartz SM, Khoury P, Strife CF (2001) Changes in left ventricular mass in children and adolescents during chronic dialysis. Pediatr Nephrol 16:318–323

    Article  CAS  Google Scholar 

  30. Berweck S, Hennig L, Sternberg C, Dingerkus H, Ludat K, Hampl H (2000) Cardiac mortality prevention in uremic patients. Therapeutic strategies with particular attention to complete correction of renal anemia. Clin Nephrol 53:S80–S85

    CAS  PubMed  Google Scholar 

  31. London GM, Guerin AP, Marchais SJ (1994) Pathophysiology of left ventricular hypertrophy in dialysis patients. Blood Purif 12:277–283

    Article  CAS  Google Scholar 

  32. Perez-Garcia R, Lopez-Gomez JM, Jofre R, Junco E, Valderrabano F (2001) Haemodialysis dose, extracellular volume control and arterial hypertension. Nephrol Dial Transplant 16 (Suppl 1):98–101

    Article  Google Scholar 

  33. Gunal AI, Karaca I, Aygen B, Yavuzkir M, Dogukan A, Celiker H (2004) Strict fluid volume control and left ventricular hypertrophy in hypertensive patients on chronic haemodialysis: a cross-sectional study. J Int Med Res 32:70–77

    Article  CAS  Google Scholar 

  34. Stevens L, Stigant C, Levin A (2002) Should hemoglobin be normalized in patients with chronic kidney disease? Semin Dial 15:8–13

    Article  Google Scholar 

  35. Ozkahya M, Ok E, Cirit M, Aydin S, Akcicek F, Basci A, Dorhout Mees EJ (1998) Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs. Nephrol Dial Transplant 13:1489–1493

    Article  CAS  Google Scholar 

  36. Fagugli RM, Pasini P, Quintaliani G, Pasticci F, Ciao G, Cicconi B, Ricciardi D, Santirosi PV, Buoncristiani E, Timio F, Valente F, Buoncristiani U (2003) Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients. Nephrol Dial Transplant 18:2332–2338

    Article  Google Scholar 

  37. Foley RN, Parfrey PS, Morgan J, Barre PE, Campbell P, Cartier P, Coyle D, Fine A, Handa P, Kingma I, Lau CY, Levin A, Mendelssohn D, Muirhead N, Murphy B, Plante RK, Posen G, Wells GA (2000) Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 58:1325–1335

    Article  CAS  Google Scholar 

  38. Strozecki P, Adamowicz A, Nartowicz E, Odrowaz-Sypniewska G, Wlodarczyk Z, Manitius J (2001) Parathormon, calcium, phosphorus, and left ventricular structure and function in normotensive hemodialysis patients. Ren Fail 23:115–126

    Article  CAS  Google Scholar 

  39. Ventura JE, Tavella N, Romero C, Petraglia A, Baez A, Munoz L (2002) Aortic valve calcification is an independent factor of left ventricular hypertrophy in patients on maintenance haemodialysis. Nephrol Dial Transplant 17:1795–1801

    Article  CAS  Google Scholar 

  40. Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 16:2796–2803

    Article  CAS  Google Scholar 

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Acknowledgements

We are grateful to Professor A. Bensman for critical reading of the manuscript and to our hemodialysis team, in particular Shalma Boudaraly, Sonja Kraft, and Linda Delbreil for their technical expertise and their highly motivated patient care.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Hôpital Armand Trousseau, 26 Av. du Docteur Netter, 75571, Paris, France

    Tim Ulinski, Julie Genty & Georges Deschênes

  2. Laboratory of Biostatistics, Pharmacology, 5 rue J.B Clément, 92296, Chatenay Malabry Cedex, France

    Christine Viau

  3. Section of Pediatric Cardiology, Hôpital Armand Trousseau, Paris, France

    Isabelle Tillous-Borde

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  1. Tim Ulinski
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  2. Julie Genty
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Correspondence to Tim Ulinski.

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Ulinski, T., Genty, J., Viau, C. et al. Reduction of left ventricular hypertrophy in children undergoing hemodialysis. Pediatr Nephrol 21, 1171–1178 (2006). https://doi.org/10.1007/s00467-006-0122-6

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  • DOI: https://doi.org/10.1007/s00467-006-0122-6

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