Myocardial functions by 3D speckle tracking echocardiography in pediatric acute kidney injury patients undergoing peritoneal versus hemodialysis

Abstract

BackgroundAcute kidney injury (AKI) is known to induce myocardial injury by the combined effect of volume load and uremic toxins. No study has compared to date the differential effect of peritoneal vs. hemodialysis in myocardial protection in the context of AKI. Objective3D speckle tracking Echocardiography is a new sensitive marker for detection of subclinical myocardial dysfunction. The aim of this study was to evaluate presence of myocardial dysfunction in patients undergoing acute peritoneal dialysis (PD) versus hemodialysis (HD) in cases of acute kidney injury (AKI). MethodsThis study included pediatric patients diagnosed with AKI that have undergone HD or PD. It included 50 children; 25 of them were cases that suffered from AKI compared to 25 healthy children. Each patient was subjected to 3D speckle tracking and tissue doppler echocardiography. ResultsCases with AKI showed evident systo-diastolic biventricular dysfunction. Parameters of LV and RV systolic functions were more impaired in HD group compared to PD group: LV GLS (HD: 13 ± 1, PD: 15 ± 1) and RV GLS (HD: 12 ± 1, PD: 16 ± 2) respectively, LV E/E' (ratio of the peak early mitral inflow velocity to the average of peak early mitral annular and basal septal diastolic velocities) (HD:13 ± 1, PD: 9 ± 1) and RV E/E' (ratio of peak early tricuspid inflow velocity to the peak early tricuspid annular diastolic velocity) (13 ± 1, PD: 9 ± 0.9). LV and RV diastolic dysfunction were more pronounced in HD group compared to PD group. Multivariate analysis showed that the best predictor of LV systolic dysfunction was the mode of dialysis, with a P value of 0.04. ConclusionHemodialysis modality in AKI seems to be less protective to the myocardium than Peritoneal dialysis. This might be attributed to rapid reduction in fluid load, which is reported to damage endothelial glycocalyx, thereby causing myocardial edema.