Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation
Childhood chronic kidney disease (CKD) and dialysis are associated with increased long-term cardiovascular risk. We examined subclinical alterations in myocardial mechanics longitudinally in children with CKD, during dialysis, and following renal transplantation.
Forty-eight children with CKD (stage III or higher) who received kidney transplants from 2008 to 2014 were included in a retrospective study and compared to 192 age- and sex-matched healthy children. Measurements of cardiac systolic and diastolic function were performed, and global longitudinal strain (GLS) and circumferential strain (GCS) were measured by speckle-tracking echocardiography at CKD, during dialysis, and 1 year following kidney transplantation. Mixed-effects modeling examined changes in GLS and GCS over different disease stages.
Children with CKD had a mean age of 10 ± 5 years and 67% were male. Eighteen children received preemptive transplantation. Children with CKD had increased left ventricular mass, lower GLS, and impaired diastolic function (lower E/A ratio and E′ velocities) than healthy children. Changes in left ventricular diastolic parameters persisted during dialysis and after renal transplantation. Dialysis was associated with reduced GLS compared to CKD (β = 1.6, 95% confidence interval 0.2–3.0); however, this was not significant after adjustment for systolic blood pressure and CKD duration. Post-transplantation GLS levels were similar to those at CKD assessment. GCS was unchanged during dialysis but significantly improved following transplantation.
There are differences in diastolic parameters in childhood CKD that persist during dialysis and after transplantation. Systolic parameters are preserved, with significant improvement in systolic myocardial deformation following transplantation. The impact of persistent diastolic changes on long-term outcomes requires further investigation.
KeywordsChronic kidney disease Dialysis Kidney transplant Myocardial mechanics Systolic strain Children
- 8.Dounousi E, Mitsis M, Naka KK, Pappas C, Lakkas L, Harisis C, Pappas K, Koutlas V, Tzalavra I, Spanos G, Michalis LK, Siamopoulos KC (2014) Differences in cardiac structure assessed by echocardiography between renal transplant recipients and chronic kidney disease patients. Transplant Proc 46:3194–3198CrossRefPubMedGoogle Scholar
- 9.Gu H, Sinha MD, Li Y, Simpson J, Chowienczyk PJ (2015) Elevated ejection-phase myocardial wall stress in children with chronic kidney disease. Hypertension. 66(4):823–829Google Scholar
- 11.Krishnasamy R, Hawley CM, Stanton T, Pascoe EM, Campbell KL, Rossi M, Petchey W, Tan KS, Beetham KS, Coombes JS, Leano R, Haluska BA, Isbel NM (2015) Left ventricular global longitudinal strain is associated with cardiovascular risk factors and arterial stiffness in chronic kidney disease. BMC Nephrol 16:106CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Kramann R, Erpenbeck J, Schneider RK, Rohl AB, Hein M, Brandenburg VM, van Diepen M, Dekker F, Marx N, Floege J, Becker M, Schlieper G (2014) Speckle tracking echocardiography detects uremic cardiomyopathy early and predicts cardiovascular mortality in ESRD. J Am Soc Nephrol 25:2351–2365CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Kovacs A, Tapolyai M, Celeng C, Gara E, Faludi M, Berta K, Apor A, Nagy A, Tisler A, Merkely B (2014) Impact of hemodialysis, left ventricular mass and FGF-23 on myocardial mechanics in end-stage renal disease: a three-dimensional speckle tracking study. Int J Cardiovasc Imaging 30:1331–1337CrossRefPubMedGoogle Scholar
- 15.Fukushima K, Javadi MS, Higuchi T, Bravo PE, Chien D, Lautamaki R, Merrill J, Nekolla SG, Bengel FM (2012) Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease: a quantitative analysis of clinical 82Rb PET/CT studies. J Nucl Med 53:887–893CrossRefPubMedGoogle Scholar
- 18.Florescu M, Benea DC, Rimbas RC, Cerin G, Diena M, Lanzzillo G, Enescu OA, Cinteza M, Vinereanu D (2012) Myocardial systolic velocities and deformation assessed by speckle tracking for early detection of left ventricular dysfunction in asymptomatic patients with severe primary mitral regurgitation. Echocardiography 29:326–333CrossRefPubMedGoogle Scholar
- 20.Mignot A, Donal E, Zaroui A, Reant P, Salem A, Hamon C, Monzy S, Roudaut R, Habib G, Lafitte S (2010) Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. J Am Soc Echocardiogr 23:1019–1024CrossRefPubMedGoogle Scholar
- 21.Chinali M, Matteucci MC, Franceschini A, Doyon A, Pongiglione G, Rinelli G, Schaefer F (2015) Advanced parameters of cardiac mechanics in children with CKD: the 4C study. Clin J Am Soc Nephrol 10:1357–1363Google Scholar
- 22.Chinali M, de Simone G, Matteucci MC, Picca S, Mastrostefano A, Anarat A, Caliskan S, Jeck N, Neuhaus TJ, Peco-Antic A, Peruzzi L, Testa S, Mehls O, Wuhl E, Schaefer F (2007) Reduced systolic myocardial function in children with chronic renal insufficiency. J Am Soc Nephrol 18:593–598CrossRefPubMedGoogle Scholar
- 28.Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11:1–190Google Scholar
- 35.Lindblad YT, Axelsson J, Balzano R, Vavilis G, Chromek M, Celsi G, Barany P (2013) Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease. Pediatr Nephrol 28:2003–2013Google Scholar