Cardiac disease in children with mild-to-moderate chronic kidney disease

Abstract

Studies in pediatric populations may provide sensitive insights into the prevalence, evolution and underlying mechanisms of cardiovascular complications of chronic kidney disease, without confounding factors such as aging and diabetes. This review reflects on recent echocardiographic studies assessing left-ventricular mass, geometry and function in children with mild-to-moderate chronic kidney disease. A cross-sectional assessment of a large pediatric cohort established a 33% prevalence of left-ventricular hypertrophy in children with chronic kidney disease stages 2-4. Concentric and eccentric geometry are found equally frequently, suggesting variable contributions of enhanced left-ventricular preload and afterload and/or nonhemodynamic mechanisms. Concentric left-ventricular hypertrophy is frequently associated with systolic dysfunction as evidenced by impaired circumferential shortening at the myocardial midwall level. Left-ventricular mass and dysfunction tend to be inversely correlated with glomerular filtration rate. Furthermore, male sex, obesity, anemia and inflammation appear to be associated with left-ventricular hypertrophy, whereas blood pressure shows surprisingly little association with left-ventricular mass, geometry or function. Significant abnormalities of cardiac morphology and function are observed in children with early chronic kidney disease, demonstrating a marked intrinsic impact on the cardiovascular system. Regular echocardiographic screening appears indicated in the pediatric population with chronic kidney disease.