Cardiac geometry in children receiving chronic peritoneal dialysis: Findings from the international pediatric peritoneal dialysis network (IPPN) registry

Sevcan A. Bakkaloglu, Dagmara Borzych, Soo Ha, Erkin Serdaroglu, Rainer Büscher, Paulina Salas, Hiren Patel, Dorota Drozdz, Karel Vondrak, Andreia Watanabe, Jorge Villagra, Onder Yavascan, María Teresa Valenzuela Bravo, Deborah Gipson, K. H. Ng, Bradley A. Warady, Franz Schaefer

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Background and objectives Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow- up in dialyzed children. Design, setting, participants, & measurements Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95th percentile of LV mass index relative to height age was used to define LVH. Results The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia. Conclusions Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH.

Original languageEnglish
Pages (from-to)1926-1933
Number of pages8
JournalClinical journal of the American Society of Nephrology : CJASN
Volume6
Issue number8
DOIs
StatePublished - 1 Aug 2011

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