1. CARDIOVASCULAR CORELATIONS IN CHILDREN WITH END STAGE RENAL DISEASE
AUTHORS
Adrian C. Lungu
Alexandra Niculae
Fundeni Clinical Institute, Bucharest, Romania – Pediatric Dialysis and Nephrology Department
Carol Davila Bucharest University of Medicine
Cristina Orlov
Cristina Stoica
INTRODUCTION
Cardiovascular involvement remains one of the leading causes of morbidity and mortality in children with Chronic Kidney Disease on Renal Replacement Therapy. Left ventricular hypertrophy, aortic calcifications, arterial stiffness and hypertension have been recognized as risk factors for sudden death in pediatric patients with end-stage renal disease. This study is designed to assess the relationship between the End Stage Renal Disease risk factors and cardiovascular events.
Methods:
This is a single center, 2 years, prospective study including 20 subjects with End Stage Renal Disease. We analyzed the plasmatic level of hemoglobin, calcium, phosphate, intact- parathyroid hormone (i-PTH), cholesterol, triglycerides, C reactive protein (CRP), serum creatinine and urea levels. Cardiovascular parameters measured were: Fluid overload, Blood Pressure, Cardiac Frequency, Left Ventricular Mass, Diastolic Dysfunction, Intima-Media Thickness. Fluid overload was clinically assessed.
Results:
All the patients included in our study had high levels of i-PTH, with secondary increase of calcium and phosphate serum levels. 45% of boys and 40% of girls presented Left Ventricular Hypertrophy, which was correlated with a high Systolic Blood Pressure, and volume overload, but not with the period of time on renal replacement therapy. Diastolic Dysfunction witch was determined as E/A waves fraction was correlated with urea levels, Systolic Blood Pressure values and volume overload. Cardiac frequency had a positive correlation with the volume overload and a negative one with Hemoglobin levels. Intima-Media Thickness had a direct positive correlation with i-PTH, calcium - phosphorous levels and product and high Systolic Blood Pressure . Dyslipidemia was not associated with arterial thickness in children with ESRD, which is an important difference as compared to adults with CKD and CVD
Left Ventricular Mass
Systolic BP
Volemic overload (L)
Dialysis Vintage (month)
Dialysis vintage positively correlats with left ventricular mass. The volemic overload is an important factor influencing the blood pressure and Left Ventricular Mass
iPTH values
Intima-media thickness
Positive linear correlation between iPTH values and (Intima-media thickness) IMT
Ca, P values (mg/dl)
CRP
Intima-media thickness
Intima-media thickness
Intima-Media Thickness had a direct positive correlation with i-PTH, calcium - phosphorous levels and product and high Systolic Blood Pressure
Conclusions:
Left Ventricular Mass is directly related to the degree of systolic blood pressure and the volume overload, but does associate Diastolic Dysfunction only in a small number of patients. Intima-Media Thickening is the result of volume overload, increased calcium-phosphorous product, but not of the inflammatory status measured by serum C-reactive protein.
Drastic reduction of volume overload in children on peritoneal dialysis and hemodialysis, the reduction of serum calcium and phosphorous levels and the correct treatment of hypertension are the most important targets for a patient with End Stage Renal Disease
E/A (Diastolic Dysfunction) intervals
Uree (mg/dl)
E/A waves fraction was correlated with urea levels, Systolic Blood Pressure values and volume overload. Cardiac frequency had a positive correlation with the volume overload and a negative one with Hemoglobin levels
AKNOWLEDGEMENT:
This paper is supported by the Sectorial Operational Programme in Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/s/137390/
Contact: Dr. Adrian Lungu ,