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Serum cystatin C and left ventricular diastolic dysfunction in children with chronic kidney disease

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Abstract

Previous studies indicate that serum cystatin C predicts incident heart failure in older adults. Children with chronic kidney disease (CKD) develop left ventricular (LV) diastolic dysfunction, often the initial abnormality of cardiac function. We hypothesized that cystatin C might predict LV diastolic dysfunction in children with CKD. Fifty-seven subjects, aged 6–21 years, with stage 2–4 CKD underwent echocardiography. Diastole was assessed from transmitral Doppler [maximum early (E wave) and late (A wave) diastolic flow velocities (E/A ratio)] and from tissue Doppler [septal mitral annular peak velocities (E′)]. LV filling pressures were determined, using a ratio of E/E′. Fourteen (25%) patients had low E′ and 15 (26%) had high E/E′. Children with abnormal E′ or E/E′ had significantly higher cystatin C levels than children with normal indices (P<0.05). Neither serum creatinine nor measured glomerular filtration rate (GFR) significantly correlated with E’ or E/E’. Stepwise multiple regression analysis showed that cystatin C (β=−0.825, P=0.023) and left ventricular mass (LVM) index (β=0.099, P=0.006) independently predicted E′; LVM index independently predicted E/E′ (β=0.0173, P=0.01). We conclude that, in contrast to measured GFR or serum creatinine level, elevated serum cystatin C might be associated with diastolic dysfunction in children with CKD.

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Acknowledgments

M.M. is supported by grants 2K12HD28827 and K23 HL69296-01 from the National Institutes of Health; P.D. is supported by grants from the NIH/NIDDK (RO1-DK069749, P50-DK52612, R21-DK070163), a Grant-in-Aid from the American Heart Association Ohio Valley Affiliate, and a Translational Research Initiative Grant from Cincinnati Children's Hospital Medical Center.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, MLC 7022, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Mark Mitsnefes, Janis Kartal, Thelma Kathman, Jaya Mishra & Prasad Devarajan

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

    Thomas Kimbal

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  1. Mark Mitsnefes
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Correspondence to Mark Mitsnefes.

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Mitsnefes, M., Kimbal, T., Kartal, J. et al. Serum cystatin C and left ventricular diastolic dysfunction in children with chronic kidney disease. Pediatr Nephrol 21, 1293–1298 (2006). https://doi.org/10.1007/s00467-006-0132-4

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  • DOI: https://doi.org/10.1007/s00467-006-0132-4

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