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Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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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Authors and Affiliations

  1. Division of Pediatrics, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden

    Ylva Tranæus Lindblad, Milan Chromek & Gianni Celsi

  2. Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    Peter Bárány

  3. Renal Research Group, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Jonas Axelsson

  4. Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

    Rita Balzano & Georgios Vavilis

  5. Astrid Lindgren Pediatric Hospital Huddinge, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden

    Ylva Tranæus Lindblad

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  1. Ylva Tranæus Lindblad
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  2. Jonas Axelsson
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  3. Rita Balzano
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  5. Milan Chromek
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Correspondence to Ylva Tranæus Lindblad.

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Lindblad, Y.T., Axelsson, J., Balzano, R. et al. Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease. Pediatr Nephrol 28, 2003–2013 (2013). https://doi.org/10.1007/s00467-013-2504-x

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