Left ventricular hypertrophy in pediatric patients on maintenance dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Abstract

Background: Cardiovascular disease is the leading cause of death in pediatric patients with kidney failure. Left ventricular hypertrophy (LVH) is recognized as the most common cardiovascular abnormality in these patients. There remains a paucity of longitudinal studies evaluating LVH during maintenance dialysis in children. NAPRTCS has collected echocardiographic data of pediatric maintenance dialysis patients since 2013 and is one of the largest registries to assess longitudinal changes in LVH.

Methods: Patients aged 1-18 years with echocardiographic data and without underlying structural cardiovascular diseases were included. LVH was defined as left ventricular mass index (LVMI, height-indexed) > 95th percentile for age and sex. Univariate and multivariable logistic regression was performed to assess risk factors for LVH at baseline. Generalized estimating equation was used to assess risk factors of changes in LVH during maintenance dialysis.

Results: A total of 518 patients had echocardiographic data available for analysis during time on maintenance dialysis. Of 179 patients with baseline echocardiography (within 30 days of dialysis initiation), 67% had LVH. In multivariable logistic regression adjusted for age, race, and sex, uncontrolled hypertension (OR 9.4, 95% CI 2.8-31) and anemia (OR 2.3, 95% CI 1.0-5.3) were associated with LVH at baseline. Prevalence of LVH remained high at 40-50% during follow-up. Controlled and uncontrolled hypertension as well as phosphorus level were independently associated with increased likelihood of LVH during maintenance dialysis.

Conclusions: LVH is prevalent in pediatric patients at dialysis initiation and remains prevalent during follow-up. Hypertension is the strongest risk factor for LVH in children on maintenance dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Cardiovascular; Children; Dialysis; Hypertension; Kidney failure; Left ventricular hypertrophy.