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Pediatric Nephrology

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01-10-2017 | Original Article

Evaluation of the coronary circulation and calcification in children on regular hemodialysis

Authors: Mohammed Al-Biltagi, Maher Ahmed Abd ElHafez, Doaa Mohamed El Amrousy, Mohamed El-Gamasy, Hesham El-Serogy

Published in: Pediatric Nephrology | Issue 10/2017

Abstract

Background

The objective of this study was to evaluate the coronary circulation and calcification in children with end-stage renal disease (ESRD) on hemodialysis.

Methods

A total of 50 children with ESRD and 50 healthy controls were enrolled in the study. Cardiac functions and coronary blood flow were evaluated with conventional and tissue Doppler echocardiography. Coronary artery calcification (CAC) was evaluated using high-resolution multidetector computed tomography (CT).

Results

The hyperemic coronary flow volume (CFV) and coronary flow reserve were significantly lower in the patient group than in the controls, while there was no significant difference in the baseline CFV between the two groups. Hypertension was present in 60% and CAC was observed in 20% of the children in the patient group. CAC was present in 30% of the children in the hypertensive subgroup. The left ventricle myocardial performance index (LV MPI), CAC score, duration of hypertension and level of diastolic blood pressure were independent predictors of the coronary blood flow, and LV MPI, serum parathyroid hormone, duration of dialysis and E′/A′ mitral valve were independent predictors of coronary calcification.

Conclusion

High diastolic blood pressure, long duration of hypertension, high LV MPI and increased CAC scores are independent risk factors for impaired coronary blood flow in children with ESRD.

Mitsnefes MM (2012) Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 23(4):578–585CrossRefPubMedPubMedCentral

Shaw C, Sharpe CC (2015) Early invasive treatment for acute coronary syndrome in patients with chronic kidney disease: do we know what we’re doing? Future Cardiol 11(1):5–8CrossRefPubMed

Chavers BM, Li S, Collins AJ, Herzog CA (2002) Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 62(2):648–653CrossRefPubMed

Milliner DS, Zinsmeister AR, Lieberman E, Landing B (1990) Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 8(5):931–936CrossRef

Civilibal M, Caliskan S, Adaletli I, Oflaz H, Sever L, Candan C, Canpolat N, Kasapcopur O, Kuruoglu S, Arisoy N (2006) Coronary artery calcifications in children with end-stage renal disease. Pediatr Nephrol. 21(10):1426–1433CrossRefPubMed

Langman CB, Brooks ER (2006) Renal osteodystrophy in children: a systemic disease associated with cardiovascular manifestations. Growth Horm IGF Res 16[Suppl A]:S79–S83CrossRefPubMed

Hakeem A, Bhatti S, Chang SM (2014) Screening and risk stratification of coronary artery disease in end-stage renal disease. JACC Cardiovasc Imaging 7(7):715–728CrossRefPubMed

Gurm HS, Gore JM, Anderson FA Jr, Wyman A, Fox KA, Steg PG, Eagle KA, Global Registry of Acute Coronary Events (GRACE) Investigators (2012) Comparison of acute coronary syndrome in patients receiving versus not receiving chronic dialysis (from the Global Registry of Acute Coronary Events [GRACE] Registry). Am J Cardiol 109(1):19–25CrossRefPubMed

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[2 Suppl 4th Report]:555–576CrossRef

10.

Abid L, Rekik H, Jarraya F, Kharrat I, Hachicha J, Kammoun S (2014) Acute hemodialysis effects on Doppler echocardiographic indices. Saudi J Kidney Dis Transpl 25(4):756–761CrossRefPubMed

11.

Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, Keller AM, Malenka DJ, Masoudi FA, McCulloch M, Pellikka PA, Peters PJ, Stainback RF, Strachan GM, Zoghbi WA, American Society of Echocardiography (2011) American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 24(1):1–10CrossRefPubMed

12.

Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22(6):709–714CrossRefPubMed

13.

Al-Biltagi M, Tolba OA, ElHafez MA, Abo-Elezz AA, El Kady EK, Hazza SM (2016) Oxidative stress and cardiac dysfunction in children with chronic renal failure on regular hemodialysis. Pediatr Nephrol 31(8):1329–3139CrossRefPubMed

14.

Harada K, Yasuoka K, Tamura M, Toyono M (2002) Coronary Flow Reserve Assessment by Doppler Echocardiography in Children with and Without Congenital Heart Defect: Comparison with Invasive Technique. J Am Soc Echocardiogr 15(10 Pt 2):1121–1126CrossRefPubMed

15.

Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, Seward SB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9:838–847CrossRefPubMed

16.

Conti CR (2016) Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging 9(3):330–331CrossRefPubMed

17.

Anderson TJ (2006) Arterial stiffness or endothelial dysfunction as a surrogate marker of vascular risk. Can J Cardiol 22(Suppl B):72B–80BCrossRefPubMedPubMedCentral

18.

Kozàkovà M, Palombo C, Pratali L, Pittella G, Galetta F, L’Abbate A (1997) Mechanisms of coronary flow reserve impairment in human hypertension. An integrated approach by transthoracic and transesophageal echocardiography. Hypertension 29(2):551–559CrossRefPubMed

19.

Mitsnefes M, Ho PL, McEnery PT (2003) Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol 14(10):2618–2622CrossRefPubMed

20.

London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, Metivier F (1996) Cardiac and arterial interactions in end-stage renal disease. Kidney Int 50(2):600–608CrossRefPubMed

21.

Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, Warady BA, Chronic Kidney Disease in Children Study Group (2008) Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension 52(4):631–637CrossRefPubMedPubMedCentral

22.

Samuels J, Ng D, Flynn JT, Mitsnefes M, Poffenbarger T, Warady BA, Furth S, Chronic Kidney Disease in Children Study Group (2012) Ambulatory blood pressure patterns in children with chronic kidney disease. Hypertension 60(1):43–50CrossRefPubMedPubMedCentral

23.

Caliskan Y, Oflaz H, Demirturk M, Yazici H, Turkmen A, Cimen A, Elitok A, Yildiz A (2008) Coronary flow reserve dysfunction in hemodialysis and kidney transplant patients. Clin Transplant 22(6):785–793CrossRefPubMed

24.

Pizzuto F, Voci P, Mariano E, Puddu PE, Chiavari PA, Romeo F (2003) Noninvasive coronary flow reserve assessed by transthoracic coronary Doppler ultrasound in patients with left anterior descending coronary artery stents. Am J Cardiol 91(5):522–526CrossRefPubMed

25.

Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, Lamberti M, Pezone N, Pota A, Russo L, Sacco M, Scognamiglio B (2011) Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 80:112–118CrossRefPubMedPubMedCentral

26.

Shemesh J, Motro M, Morag-Koren N, Tenenbaum A, Apter S, Weiss A, Grossman E (2011) Coronary artery calcification predicts long-term mortality in hypertensive adults. Am J Hypertens 24(6):681–686CrossRefPubMed

27.

Urena-Torres PA, Floege J, Hawley CM, Pedagogos E, Goodman WG, Petavy F, Reiner M, Raggi P (2013) Protocol adherence and the progression of cardiovascular calcification in the ADVANCE study. Nephrol Dial Transplant 28(1):146–152CrossRefPubMed

28.

Neves PD, Bridi RA, Elias RM, Moyses RM (2015) Coronary artery calcification seen through chest radiography. J Clin Med Res 7(9):724–725CrossRefPubMedPubMedCentral

29.

Lumpaopong A, Mathew AV, John E, Jelnin V, Benedetti E, Testa G, Oberholzer J, Sankary H, Ruiz C (2007) Early coronary calcification in children and young adults with endstage renal disease. Transplant Proc 39(1):37–39CrossRefPubMed

30.

Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE (2009) The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol 53(23):2129–4210CrossRefPubMed

31.

Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342(20):1478–1483CrossRefPubMed

32.

Matsuoka M, Iseki K, Tamashiro M, Fujimoto N, Higa N, Touma T, Takishita S (2004) Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol 8(1):54–58CrossRefPubMed

33.

Cui L, Xu J, Bai Y, Zhang J (2015) Risk factors for coronary artery calcification in patients with end-stage renal disease. Zhonghua Yi Xue Za Zhi 95(38):3133–3137PubMed

34.

Iyer H, Abraham G, Reddy YN, Pandurangi UM, Kalaichelvan U, Gomathi SB, Mathew M, Santhosham R (2013) Risk factors of chronic kidney disease influencing cardiac calcification. Saudi J Kidney Dis Transpl 24(6):1189–1194CrossRefPubMed

Title: Evaluation of the coronary circulation and calcification in children on regular hemodialysis
Authors: Mohammed Al-Biltagi
Maher Ahmed Abd ElHafez
Doaa Mohamed El Amrousy
Mohamed El-Gamasy
Hesham El-Serogy
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 10/2017
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-017-3678-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Evaluation of the coronary circulation and calcification in children on regular hemodialysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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