Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Pediatric Nephrology
Published in: Pediatric Nephrology 10/2013

01-10-2013 | Original Article

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

Authors: Ylva Tranæus Lindblad, Jonas Axelsson, Rita Balzano, Georgios Vavilis, Milan Chromek, Gianni Celsi, Peter Bárány

Published in: Pediatric Nephrology | Issue 10/2013

Login to get access

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.
Literature
1.
McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662PubMedCrossRef
2.
Groothoff J, Gruppen M, de Groot E, Offringa M (2005) Cardiovascular disease as a late complication of end-stage renal disease in children. Perit Dial Int 25[Suppl 3]:S123–S126PubMed
3.
Parekh RS, Carroll CE, Wolfe RA, Port FK (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197PubMedCrossRef
4.
Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105PubMedCrossRef
5.
Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR (1996) Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 50:998–1006PubMedCrossRef
6.
Matteucci MC, Wuhl E, Picca S, Mastrostefano A, Rinelli G, Romano C, Rizzoni G, Mehls O, de Simone G, Schaefer F (2006) Left ventricular geometry in children with mild to moderate chronic renal insufficiency. J Am Soc Nephrol 17:218–226PubMedCrossRef
7.
Mitsnefes MM, Kimball TR, Border WL, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Impaired left ventricular diastolic function in children with chronic renal failure. Kidney Int 65:1461–1466PubMedCrossRef
8.
9.
Hayashi SY, Rohani M, Lindholm B, Brodin LA, Lind B, Barany P, Alvestrand A, Seeberger A (2006) Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant 21:125–132PubMedCrossRef
10.
Otsuka T, Suzuki M, Yoshikawa H, Sugi K (2009) Left ventricular diastolic dysfunction in the early stage of chronic kidney disease. J Cardiol 54:199–204PubMedCrossRef
11.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193PubMedCrossRef
12.
Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 16:2796–2803PubMedCrossRef
13.
Tafreshi RI, Human N, Otukesh H, Nikavar A (2011) Evaluation of combined left ventricular function using the myocardial performance index in children with chronic kidney disease. Echocardiography 28:97–103PubMedCrossRef
14.
Mitsnefes MM, Kimball TR, Border WL, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Abnormal cardiac function in children after renal transplantation. Am J Kidney Dis 43:721–726PubMedCrossRef
15.
Ten Harkel AD, Cransberg K, Van Osch-Gevers M, Nauta J (2009) Diastolic dysfunction in paediatric patients on peritoneal dialysis and after renal transplantation. Nephrol Dial Transplant 24:1987–1991PubMedCrossRef
16.
Muscheites J, Meyer AA, Drueckler E, Wigger M, Fischer DC, Kundt G, Kienast W, Haffner D (2008) Assessment of the cardiovascular system in pediatric chronic kidney disease: a pilot study. Pediatr Nephrol 23:2233–2239PubMedCrossRef
17.
Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500PubMedCrossRef
18.
Litwin M, Wuhl E, Jourdan C, Niemirska A, Schenk JP, Jobs K, Grenda R, Wawer ZT, Rajszys P, Mehls O, Schaefer F (2008) Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease. Nephrol Dial Transplant 23:2552–2557PubMedCrossRef
19.
Pecoits-Filho R, Barany P, Lindholm B, Heimburger O, Stenvinkel P (2002) Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant 17:1684–1688PubMedCrossRef
20.
Shinohara K, Shoji T, Emoto M, Tahara H, Koyama H, Ishimura E, Miki T, Tabata T, Nishizawa Y (2002) Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 13:1894–1900PubMedCrossRef
21.
Sebekova K, Podracka L, Heidland A, Schinzel R (2001) Enhanced plasma levels of advanced glycation end products (AGE) and pro-inflammatory cytokines in children/adolescents with chronic renal insufficiency and after renal replacement therapy by dialysis and transplantation—are they inter-related. Clin Nephrol 56:S21–S26PubMed
22.
Nairn J, Hodge G, Henning P (2005) Changes in leukocyte subsets: clinical implications for children with chronic renal failure. Pediatr Nephrol 20:190–196PubMedCrossRef
23.
Ece A, Gurkan F, Kervancioglu M, Kocamaz H, Gunes A, Atamer Y, Selek S (2006) Oxidative stress, inflammation and early cardiovascular damage in children with chronic renal failure. Pediatr Nephrol 21:545–552PubMedCrossRef
24.
Silverstein DM, Mitchell M, LeBlanc P, Boudreaux JP (2007) Assessment of risk factors for cardiovasuclar disease in pediatric renal transplant patients. Pediatr Transplant 11:721–729PubMedCrossRef
25.
Prokai A, Fekete A, Kis E, Reusz GS, Sallay P, Korner A, Wagner L, Tulassay T, Szabo AJ (2008) Post-transplant diabetes mellitus in children following renal transplantation. Pediatr Transplant 12:643–649PubMedCrossRef
26.
Lindblad YT, Axelsson J, Barany P, Celsi G, Lindholm B, Qureshi AR, Carrea A, Canepa A (2008) Hyperinsulinemia and insulin resistance, early cardiovascular risk factors in children with chronic kidney disease. Blood Purif 26:518–525PubMedCrossRef
27.
Lai HL, Kartal J, Mitsnefes M (2007) Hyperinsulinemia in pediatric patients with chronic kidney disease: the role of tumor necrosis factor-alpha. Pediatr Nephrol 22:1751–1756PubMedCrossRef
28.
Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedCrossRef
29.
Brito VN, Batista MC, Borges MF, Latronico AC, Kohek MB, Thirone AC, Jorge BH, Arnhold IJ, Mendonca BB (1999) Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab 84:3539–3544PubMedCrossRef
30.
Elmlinger MW, Kuhnel W, Wormstall H, Doller PC (2005) Reference intervals for testosterone, androstenedione and SHBG levels in healthy females and males from birth until old age. Clin Lab 51:625–632PubMed
31.
Norjavaara E, Ankarberg C, Albertsson-Wikland K (1996) Diurnal rhythm of 17 beta-estradiol secretion throughout pubertal development in healthy girls: evaluation by a sensitive radioimmunoassay. J Clin Endocrinol Metab 81:4095–4102PubMedCrossRef
32.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576
33.
Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007PubMedCrossRef
34.
Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C (2005) Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 115:e500–e503PubMedCrossRef
35.
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458PubMedCrossRef
36.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108PubMedCrossRef
37.
Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 30:8–18PubMedCrossRef
38.
Frommelt PC (2006) Echocardiographic measures of diastolic function in pediatric heart disease. Curr Opin Cardiol 21:194–199PubMedCrossRef
39.
Balzano R, Lindblad YT, Vavilis G, Jogestrand T, Berg UB, Krmar RT (2011) Use of annual ABPM, and repeated carotid scan and echocardiography to monitor cardiovascular health over nine yr in pediatric and young adult renal transplant recipients. Pediatr Transplant 15:635–641PubMed
40.
Wikland KA, Luo ZC, Niklasson A, Karlberg J (2002) Swedish population-based longitudinal reference values from birth to 18 years of age for height, weight and head circumference. Acta Paediatr 91:739–754PubMedCrossRef
41.
Rolland-Cachera MF, Sempe M, Guilloud-Bataille M, Patois E, Pequignot-Guggenbuhl F, Fautrad V (1982) Adiposity indices in children. Am J Clin Nutr 36:178–184PubMed
42.
Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2006) Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 149:671–675PubMedCrossRef
43.
El-Husseini AA, Sheashaa HA, Hassan NA, El-Demerdash FM, Sobh MA, Ghoneim MA (2004) Echocardiographic changes and risk factors for left ventricular hypertrophy in children and adolescents after renal transplantation. Pediatr Transplant 8:249–254PubMedCrossRef
44.
Matteucci MC, Chinali M, Rinelli G, Wuhl E, Zurowska A, Charbit M, Pongiglione G, Schaefer F (2013) Change in cardiac geometry and function in CKD children during strict bp control: a randomized study. Clin J Am Soc Nephrol 8:203–210PubMedCrossRef
45.
Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT (2010) Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 375:2073–2081PubMedCrossRef
46.
Edfeldt K, Agerberth B, Rottenberg ME, Gudmundsson GH, Wang XB, Mandal K, Xu Q, Yan ZQ (2006) Involvement of the antimicrobial peptide LL-37 in human atherosclerosis. Arterioscler Thromb Vasc Biol 26:1551–1557PubMedCrossRef
47.
Kanbay M, Ikizek M, Solak Y, Selcoki Y, Uysal S, Armutcu F, Eryonucu B, Covic A, Johnson RJ (2011) Uric acid and pentraxin-3 levels are independently associated with coronary artery disease risk in patients with stage 2 and 3 kidney disease. Am J Nephrol 33:325–331PubMedCrossRef
48.
Tong M, Carrero JJ, Qureshi AR, Anderstam B, Heimburger O, Barany P, Axelsson J, Alvestrand A, Stenvinkel P, Lindholm B, Suliman ME (2007) Plasma pentraxin 3 in patients with chronic kidney disease: associations with renal function, protein-energy wasting, cardiovascular disease, and mortality. Clin J Am Soc Nephrol 2:889–897PubMedCrossRef
49.
Kirkpantur A, Kahraman S, Genctoy G, Altun B, Abali G, Arici M, Turgan C (2008) The interleukin-10 promoter genotype predicts diastolic dysfunction in maintenance hemodialysis patients. Hemodial Int 12:352–361PubMedCrossRef
50.
Canpolat N, Caliskan S, Sever L, Guzeltas A, Kantarci F, Candan C, Civilibal M, Kasapcopur O, Arisoy N (2012) Glucose intolerance: is it a risk factor for cardiovascular disease in children with chronic kidney disease? Pediatr Nephrol 27:627–635PubMedCrossRef
Metadata
Title
Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease
Authors
Ylva Tranæus Lindblad
Jonas Axelsson
Rita Balzano
Georgios Vavilis
Milan Chromek
Gianni Celsi
Peter Bárány
Publication date
01-10-2013
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 10/2013
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-013-2504-x

Other articles of this Issue 10/2013

Pediatric Nephrology 10/2013 Go to the issue

Brief Report

NPHS2 homozygous p.R229Q variant: potential modifier instead of causal effect in focal segmental glomerulosclerosis

Original Article

Vitamin D in nephrotic syndrome remission: a case–control study

Brief Report

Successful treatment of central nervous system PTLD with rituximab and cranial radiotherapy

Educational Review

Is obesity a risk factor for chronic kidney disease in children?

Brief Report

Hemolytic uremic syndrome complicating Mycoplasma pneumoniae infection

Original Article

The role of urinary TGF-β1, TNF-α, IL-6 and microalbuminuria for monitoring therapy in posterior urethral valves