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

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Abstract

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.

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Authors and Affiliations

  1. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong, China

    Ann Wing-man Choi, Nai-chung Fong, Tsz-wai Ho, Eugene Yu-hin Chan & Alison Lap-tak Ma

  2. Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China

    Vivian Wing-yi Li & Yiu-fai Cheung

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  1. Ann Wing-man Choi
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Correspondence to Yiu-fai Cheung.

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The study was approved by the Institutional Review Board of the Hospital Authority, Kowloon West Cluster, Hong Kong, China, and the study protocol conformed to approved guidelines and regulations.

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Choi, A.Wm., Fong, Nc., Li, V.Wy. et al. Left ventricular stiffness in paediatric patients with end-stage kidney disease. Pediatr Nephrol 35, 1051–1060 (2020). https://doi.org/10.1007/s00467-020-04484-9

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