Early cardiac dysfunction in pediatric patients on maintenance dialysis and post kidney transplant

Pediatr Nephrol. 2012 Jul;27(7):1157-64. doi: 10.1007/s00467-012-2124-x. Epub 2012 Feb 23.


Background: Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31P MRS) to assess markers of cardiac dysfunction in young CKD patients.

Methods: Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison.

Results: All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r= -0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02).

Conclusion: Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Cross-Sectional Studies
  • Heart / physiopathology
  • Heart Diseases / etiology
  • Heart Diseases / physiopathology*
  • Humans
  • Hypertrophy, Left Ventricular / complications*
  • Hypertrophy, Left Ventricular / physiopathology
  • Kidney Transplantation / adverse effects
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Myocardium / metabolism
  • Myocardium / pathology
  • Renal Dialysis
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / physiopathology
  • Stroke Volume
  • Young Adult