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01-10-2019 | Original Article

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

Authors: Nabil Melhem, Alex Savis, Arran Wheatley, Helen Copeman, Kay Willmott, Christopher J. D. Reid, John Simpson, Manish D. Sinha

Published in: Pediatric Nephrology | Issue 10/2019

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/m^2.7, 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/m^2.7 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/m^2.7 vs. 38.6 ± 14.7 g/m^2.7, 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.

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Title: Improved blood pressure and left ventricular remodelling in children on chronic intermittent haemodialysis: a longitudinal study
Authors: Nabil Melhem
Alex Savis
Arran Wheatley
Helen Copeman
Kay Willmott
Christopher J. D. Reid
John Simpson
Manish D. Sinha
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 10/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-019-04272-0

At a glance: The STEP trials

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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