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Improved blood pressure and left ventricular remodelling in children on chronic intermittent haemodialysis: a longitudinal study

  • Nabil Melhem
  • Alex Savis
  • Arran Wheatley
  • Helen Copeman
  • Kay Willmott
  • Christopher J. D. Reid
  • John Simpson
  • Manish D. SinhaEmail author
Original Article
Part of the following topical collections:
  1. What's New in Dialysis

Abstract

Objectives

We aimed to examine longitudinal changes in left ventricular (LV) structure and function and evaluate factors associated with LV remodelling in children on chronic haemodialysis.

Methods

Retrospective longitudinal study including all children from the start of chronic haemodialysis with two or more m-mode 2D echocardiograms and tissue Doppler studies. Left ventricular mass (LVM) in g/m2.7, geometry and LV function were compared at baseline (dialysis start) with follow-up studies at least 6 months following commencement. Left ventricular hypertrophy (LVH) was defined if greater than 95th percentile as per age-specific centiles. We also defined LVH as indexed LV mass index (LVMI) > 51 g/m2.7 and using LV mass-for-height z-scores greater than the 95th percentile. Biochemical data, interdialytic weight change and blood pressure level were assessed for their association with change in indexed LVM.

Results

Twenty-three of the 32 children < 18 years were included (n = 5, < 5 years) with last follow-up study performed following dialysis after a median (IQR) of 21 (10–34) months. The prevalence of LVH reduced significantly (69.6%, (n = 16/23) vs. 39.1% (n = 9/23), P = 0.002); LV geometry improved (13% concentric and 56.5% eccentric vs. 8.7% and 17.4% respectively) with mean ± SD reduction in indexed LVM (50.8 ± 23.1 g/m2.7 vs. 38.6 ± 14.7 g/m2.7, P = 0.002) and LV mass-for-height z-scores (0.67 ± 1.66 vs. − 0.46 ± 1.88, P = 0.002) from baseline to last follow-up respectively. There was no change in systolic function (LV fractional shortening, 37% vs. 38%, P = 0.39) and diastolic function (mean E/E′ 10.8 vs. 9.0, P = 0.09). Multiple regression analysis identified improved systolic BP control (β = 0.41, P = 0.04) as an independent predictor for change in indexed LVM.

Conclusions

LV structure and function can improve in children despite long-term chronic intermittent haemodialysis. Cardiovascular health in this population does not always deteriorate but can be stabilised and indeed improved with optimal blood pressure management.

Keywords

Dialysis ESKD Renal replacement therapy Cardiac 

Notes

Sources of funding

The authors (JMS and MDS) acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre and Clinical Research Facilities awards to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

The results presented in this paper have not been published previously in whole or part.

Ethical approval

The authors confirm that as this was a retrospective analysis evaluating results of clinical investigations; no consent from patients was indicated and ethical approval was not required.

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Copyright information

© IPNA 2019

Authors and Affiliations

  1. 1.Department of Paediatric NephrologyEvelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation TrustLondonUK
  2. 2.Department of Paediatric CardiologyEvelina London Children’s Hospital, Guy’s & ST Thomas’ Foundation Hospitals NHS TrustLondonUK
  3. 3.Kings College LondonLondonUK

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