Abstract 19475: Cardiovascular Burden in Children With Chronic Kidney Disease

Abstract

Introduction: Cardiovascular disease is the leading cause of death in children and young adults with chronic kidney disease (CKD) and kidney transplant. Phenotype of cardiac involvement may be variable. In adults with CKD, diastolic dysfunction has been shown to be an independent risk factor for mortality. However, there is overall very limited data in pediatric age group. Additionally, there are no guidelines for appropriate screening, assessment or standardized follow-up for cardiac pathology in pediatric CKD. The purpose of this study is to assess the overall cardiovascular burden and more specifically, diastolic dysfunction (DD) in pediatric CKD patients. Methods: Single center, retrospective cohort study of patients seen for CKD. Results: 237 patients with CKD /ESRD were identified including 64 patients who underwent renal transplant and 84 on chronic dialysis. Mean age was 14 years (7.6 to 17.5). Systolic hypertension was present in 49.7% while diastolic hypertension in 36.1%. 22% had a BMI greater than 95% percentile. Echocardiographic assessment showed preserved systolic function in majority (mean ejection fraction of 67.8%, range 19-90%). However, LV mass index(LVMI) was > 38 g/m2.7 in 66% (115/173). Tissue Doppler velocities demonstrated a large variation with significant abnormalities indicating abnormal myocardial performance and diastolic dysfunction. Mitral e velocity which was diminished in 79% while severely diminished in 31%. Mitral a,s and E/e’ velocities were abnormal in varying portion of population. Relative wall thickness was significantly increased (>0.41) in 112/213 patients. Serial measures showed a gradual increase in E/e’ ratio mean from 8.1 to 9.9 and increase in LVMI from mean of 44.5 to 53.1 g/m2.7 (p<0.05). Conclusion: This is the largest study to date of demonstrating a significant cardiovascular burden in patients with CKD in the form of hypertrophy as well as abnormalities of myocardial performance and diastolic function. Serial measures show the parameters correlate with disease state. Further analysis in underway to identify risk factors and propose guidelines for serial screening.