Left ventricular stiffness in paediatric patients with end-stage kidney disease

Pediatr Nephrol. 2020 Jun;35(6):1051-1060. doi: 10.1007/s00467-020-04484-9. Epub 2020 Feb 3.


Background: We tested the hypothesis that myocardial stiffness is altered in paediatric patients with end-stage kidney disease (ESKD) and explored its association with clinical parameters of chronic kidney disease (CKD).

Methods: Thirty-five patients with ESKD (16 males) aged 17.5 ± 3 years old, 18/35 of whom were receiving dialysis and 17 post kidney transplant, were studied. Left ventricular (LV) myocardial stiffness was determined by measurement of diastolic wall strain (DWS) and stiffness index (SI), while LV diastolic function was interrogated by pulsed-wave and tissue Doppler echocardiography.

Results: Compared with available literature data, both dialysis and transplanted patients had significantly lower DWS and greater SI, reduced transmitral early (E) to late diastolic velocity ratio and septal and lateral mitral annular early (e') diastolic velocities, and greater septal and lateral E/e' ratios (all p < 0.05). Multivariate analysis revealed that z score of diastolic blood pressure (β = 0.43, p = 0.004) and the duration of renal replacement therapy (β = 0.55, p < 0.001) were significant determinants of LV SI. Subgroup analysis in post-transplant patients showed z score of diastolic blood pressure (β = 0.54, p = 0.025) remained as a significant determinant of LV SI.

Conclusion: Increased LV myocardial stiffness is evident in paediatric dialysis and transplanted patients with ESKD, and is associated with blood pressure and duration of renal replacement therapy.

Keywords: Children; Chronic kidney disease; Diastolic wall strain; Myocardial stiffness; Paediatric end-stage kidney disease; Stiffness index.

MeSH terms

  • Adolescent
  • Adult
  • Echocardiography, Doppler
  • Female
  • Heart Ventricles / physiopathology*
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation
  • Male
  • Renal Dialysis
  • Retrospective Studies
  • Ventricular Dysfunction, Left / etiology*
  • Young Adult