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.

中文翻译：

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终末期肾脏疾病的小儿患者的左心室僵硬。

背景技术我们测试了患有终末期肾脏病（ESKD）的小儿患者心肌硬度改变的假说，并探讨了其与慢性肾脏病（CKD）的临床参数之间的关系。方法研究对象为17.5±3岁的35例ESKD患者（男16例），其中18/35接受了透析，肾脏移植后接受了17例。左室（LV）心肌的刚度通过测量舒张壁张力（DWS）和刚度指数（SI）来确定，而左室舒张功能通过脉冲波和组织多普勒超声检查。结果与现有文献数据相比，透析患者和移植患者的DWS显着降低，SI升高，舒张早期（E）至舒张末期速速比降低，以及二尖瓣中隔和外侧二尖瓣环早期（e' ）舒张速度，以及更大的间隔和外侧E / e'比（所有p <0.05）。多因素分析显示，舒张压的z评分（β= 0.43，p = 0.004）和肾脏替代治疗的持续时间（β= 0.55，p <0.001）是LV SI的重要决定因素。移植后患者的亚组分析显示，舒张压的z评分（β= 0.54，p = 0.025）仍然是LV SI的重要决定因素。结论在小儿透析和ESKD移植患者中，左室心肌僵硬度明显升高，并且与血压和肾脏替代治疗的持续时间有关。004）和肾脏替代治疗的持续时间（β= 0.55，p <0.001）是LV SI的重要决定因素。移植后患者的亚组分析显示，舒张压的z评分（β= 0.54，p = 0.025）仍然是LV SI的重要决定因素。结论在小儿透析和ESKD移植患者中，左室心肌僵硬度明显升高，并且与血压和肾脏替代治疗的持续时间有关。004）和肾脏替代治疗的持续时间（β= 0.55，p <0.001）是LV SI的重要决定因素。移植后患者的亚组分析显示，舒张压的z评分（β= 0.54，p = 0.025）仍然是LV SI的重要决定因素。结论在小儿透析和ESKD移植患者中，左室心肌僵硬度明显升高，并且与血压和肾脏替代治疗的持续时间有关。