ESPN 50th Annual Meeting

ESPN 2017


 
Improved left ventricular structure and function in children on chronic haemodialysis: a longitudinal study
NABIL MELHEM 1 ALEX SAVIS 2 ARRAN WHEATLEY 1 HELEN COPEMAN 1 KAY WILMOTT 1 CHRISTOPHER JD REID 1 JOHN SIMPSON 2 MANISH D SINHA 1

1- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, EVELINA LONDON CHILDREN’S HOSPITAL, UK
2- DEPARTMENT OF PAEDIATRIC CARDIOLOGY, EVELINA LONDON CHILDREN’S HOSPITAL, UK
 
Introduction:

Our aim in this study was to examine longitudinal changes in left ventricular (LV) structure and function and to evaluate factors associating with LV adaptation in children on chronic haemodialysis.

Material and methods:

Retrospective longitudinal study in a paediatric dialysis centre over past 4 years. Children on chronic haemodialysis with 2 m-mode 2D echocardiograms and tissue doppler studies were included. Indexed LV mass (LVM) in g/m2.7, geometry and LV function were compared at baseline (dialysis start) with follow-up studies at least 6 months following commencement. Left ventricular hypertrophy (LVH) was defined as indexed LVM>51g/m2.7. We estimated fluid volume status using averaged interdialytic weight changes over 4 weeks prior to echocardiography, and blood pressure (BP) was analysed using 24-hour ambulatory monitoring and routine aneroid BP measurements pre- and post-dialysis. Stepwise multiple regression analysis was performed to assess factors associating with LVM index change.

Results:

24 of 32 children <18 years were included (n=6 <5years) with last follow-up scan performed following median dialysis duration of 19 months (range 6-64). The prevalence of LVH at baseline was 45.8% (12.5% concentric, 33.3% eccentric) compared with 20.8% (no concentric, 20.8% eccentric) on follow-up, with reduction in mean indexed LVM from 52.3g/m2.7 to 39.4g/m2.7 (p=0.001); similar changes were observed for LV mass-for-height z-scores (0.71 vs. -0.43; p=0.001). Mean fractional shortening changed from 37% to 38% (p=0.51) and mean E/E’ improved from 10.9 to 9.1 (p=0.04). Multiple regression analysis identified improved systolic BP control and younger age at dialysis commencement as independent predictors for indexed LVM change (p=0.017 and 0.042 respectively).

Conclusions:

We report improvement in LV structure and function in children despite being on chronic intermittent haemodialysis. Encouragingly, these findings suggest that cardiovascular health in this population does not always deteriorate but can be stabilised and indeed improved with good BP management over time.