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Changes of cardiac functions after hemodialysis session in pediatric patients with end-stage renal disease: conventional echocardiography and two-dimensional speckle tracking study

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Abstract

Background

Although acute effects of hemodialysis (HD) on cardiac functions in end-stage renal disease (ESRD) have been studied frequently in adults, limited data are available in pediatric age. Therefore, this work elucidates the acute impact of HD on cardiac functions using conventional echocardiography and two-dimensional (2D) speckle tracking in ESRD pediatric patients.

Methods

Between June 2018 and April 2019, 40 ESRD pediatric subjects on chronic HD were prospectively recruited. All patients were subjected to history taking and baseline laboratory tests. Anthropometric measures, heart rate, blood pressure, and bioimpedance were assessed before and after HD session. Moreover, conventional echocardiography including M.mode and Doppler parameters for valves, as well as left ventricle (LV) 2D speckle tracking were performed pre- and post-dialysis session.

Results

The included patients mean age was 12.9 ± 2.9 years, and males were 24 (60%). Significant reductions in body weight and blood pressure were noted after sessions. Post-dialysis LV and left atrial diameters, as well as left atrium to aortic diameter ratio, were lower. Nevertheless, conventional echocardiography-derived LV ejection fraction (EF), and fractional shortening were not significantly changed. Doppler-derived E/A ratio of mitral and tricuspid valves were lower post-dialysis. Global longitudinal strain (GLS) for LV was significantly reduced after dialysis (− 20.31 ± 3.58%, − 17.17 ± 3.40% vs, P < 0.0001), and global circumferential strain (GCS) was lower post-dialysis in comparison to pre-dialysis (− 21.37 ± 6.46% vs − 17.74 ± 6.16%, P < 0.0001). The speckle tracking–derived EF was significantly lower post-dialysis (57.58 ± 6.94 vs 53.64 ± 10.72, P = 0.018). All myocardial segments longitudinal and circumferential strains decreased significantly after dialysis.

Conclusions

Post-hemodialysis significant decline in left ventricular EF as well as global and segmental strains can be detected in ESRD pediatric patients using 2D speckle tracking, despite the nonsignificant changes in systolic functions derived from conventional echocardiography. This is considered additional evidence of HD deleterious effect on myocardial functions, particularly in the pediatric age.

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Authors and Affiliations

  1. Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, El Gomhouria St, Mansoura, 35516, Egypt

    Shaimaa Rakha & Mona Hafez

  2. Pediatric Nephrology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt

    Ashraf Bakr & Nashwa Hamdy

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  1. Shaimaa Rakha
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Correspondence to Shaimaa Rakha.

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The study was a prospective comparative study before and after HD sessions. The research was approved by the IRB (institutional review board) of Mansoura University, faculty of medicine. Informed consent was obtained from a parent of each participant included in the study.

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The authors declare that they have no competing interests.

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Rakha, S., Hafez, M., Bakr, A. et al. Changes of cardiac functions after hemodialysis session in pediatric patients with end-stage renal disease: conventional echocardiography and two-dimensional speckle tracking study. Pediatr Nephrol 35, 861–870 (2020). https://doi.org/10.1007/s00467-019-04460-y

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