SUN-090 STRUCTURAL AND FUNCTIONAL (SYSTOLIC) MYOCARDIAL DYSFUNCTION AND THEIR CORRELATION WITH BLOOD PRESSURE, HEMOGLOBIN AND PARATHORMONE LEVEL IN CHILDREN WITH END STAGE RENAL DISEASE

Abstract

Myocardial dysfunction is the leading cause of morbidity in children with end stage renal disease (ESRD) and mostly associated with hypertension, anemia and high parathormone (PTH) level. Not only functional but also structural myocardial changes play a role in this event. But these changes are not very well studied in our population. So, with a view of answering the research question, what are the structural and functional changes in myocardium in children with ESRD, we designed this study. Thirty diagnosed children with ESRD (based on eGFR <15ml/min/1.73m2) were included purposively in this prospective cross sectional study in the department of pediatric nephrology of a tertiary care hospital in Bangladesh over 1 year period (from January 2017 to December 2017). All the patients underwent color Doppler echocardiography for evaluation for structural and functional (systolic) cardiac abnormalities. Thirty age and sex match healthy children were taken as comparison and also to get normal echocardiographic findings. Left atrial diameter (LA), left ventricular internal diameter in systole (LVIDs) and diastole (LVIDd), left ventricular posterior wall thickness in systole (LVPWs) and diastole (LVPWd) were considered as structural variables, ejection fraction (EF) and fractional shortening (FS) were considered as systolic function variable. Correlation of blood pressure (BP), hemoglobin (Hb) and PTH level with structural and functional variable were also observed in the study subjects. Twenty one (70%) children were male and 9 (30%) were female and their mean age at presentation was 12.23±3.20 year. Mean systolic BP was 120±16 mm Hg and mean diastolic BP was 77±14 mm Hg, mean Hb level was 8.00±1.48 gm/dl and mean serum PTH level was 548.46±309.01. Echocardiographic findings revealed statistically significant difference in case and comparison group in relation with LA, LVIDd, LVIDs, LVPWs and LVPWd (p<0.001) but no difference in relation to FS (p=0.934) and EF (p=0.754). There was negative correlation of BP, Hb and PTH level with EF (r=-0.098, -0.107 and -0.045 respectively) and FS (r=-0.123, -0.271 and -0.169 respectively) but not statistically significant. BP and PTH level was positively correlated with LVIDs (r=0.099, 0.097) and LVIDd (r=0.109, 0.074) though not statistically significant. Positive correlation was observed between Hb level with LVIDd and LVIDs and was statistically significant (r= 0.518, p=0.016 and r=0.044, p=0.046 respectively). It can be concluded from present study that children with ESRD are prone to develop cardiac dysfunction specially left ventricular structural abnormality and there is negative correlation of BP, Hb and PTH level with functional change and positive correlation of with structural change.