Anaemia and hypoalbuminemia as risk factors for left ventricular diastolic dysfunction in children with chronic kidney disease on peritoneal dialysis

Abstract

IntroductionLeft ventricular diastolic dysfunction (LVDD) is an independent predictor of mortality in Chronic Kidney Disease (CKD). The increase in the E/E′ ratio is an indicator of LVDD. The association between cardiovascular risk factors (CVRFs) and E/E′ in children with automated peritoneal dialysis (APD) has not been widely studied. ObjectiveTo measure the association between CVRFs and E/E′ in children with CKD on APD. MethodsCross-sectional, prolective, observational, analytical study of children aged 6–16 years on APD. We recorded age, gender, time since onset, time on dialysis, and measured weight, height, blood pressure, haemoglobin, albumin, calcium, phosphorus, parathyroid hormone, and C-reactive protein. E/E′ ratio was measured and considered to have increased when it was higher than 15. ResultsTwenty-nine children were studied, (19 females). Age was 14.0±2.5 years, and 16.9±11.2 months with substitutive therapy. One patient had reduced left ventricular ejection fraction, and 21 (72.4%) had increased E/E′. E/E′ correlated significantly with haemoglobin (r=–0.53, p=0.003). Haemoglobin and albumin were significantly lower (9.72±1.9 vs. 12.2±1.8; p=0.004 and 3.6±0.5 vs. 4.0±0.3; p=0.035) and the proportion of patients with anaemia and hypoalbuminemia was significantly higher (85.7% vs. 37.5%; p=0.019 and 61.9% vs. 12.5%; p=0.035) in patients with increased E/E′. Haemoglobin was the only independent predictor of E/E′ (β=–0.66; p=0.020) and patients with anaemia were 10 times more likely to have increased E/E′ (95% CI 1.5–65.6, p=0.016). Conclusions75% of the children had increased E/E′. Anaemia and hypoalbuminemia were significantly related with an increased E/e’.