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Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Institute of Medical Science, and the Cardiovascular Sciences Collaborative Program, University of Toronto, Toronto, ON, Canada

    Rawan K. Rumman

  2. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada

    Rawan K. Rumman, Rahul Chanchlani & Mikaeel Ghany

  3. Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Ronand Ramroop, Luc Mertens & Michael Grattan

  4. Division of Nephrology, Department of Pediatrics, McMaster Children’s Hospital–McMaster University, Hamilton, ON, Canada

    Rahul Chanchlani

  5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Rahul Chanchlani

  6. Division of Nephrology, The Hospital for Sick Children–University of Toronto, Toronto, ON, Canada

    Diane Hebert, Elizabeth A. Harvey & Rulan S. Parekh

  7. Department of Pediatrics, Hospital for Sick Children and Medicine, University Health Network–University of Toronto, Toronto, ON, Canada

    Rulan S. Parekh & Luc Mertens

  8. Department of Pediatrics, Children’s Hospital, London Health Sciences Centre , University of Western Ontario, London, ON, Canada

    Michael Grattan

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  1. Rawan K. Rumman
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Corresponding author

Correspondence to Luc Mertens.

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The authors have no conflicts of interest to declare.

Ethical approval

The study protocol was approved by the Research Ethics Board at the Hospital for Sick Children. For this type of study formal consent is not required.

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Rumman, R.K., Ramroop, R., Chanchlani, R. et al. Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation. Pediatr Nephrol 32, 1401–1410 (2017). https://doi.org/10.1007/s00467-017-3622-7

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  • DOI: https://doi.org/10.1007/s00467-017-3622-7

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