Free Water Transport and its Association with Cardiovascular Status in Children on Peritoneal Dialysis

2019 ◽  
Vol 39 (4) ◽  
pp. 323-329
Author(s):  
Lilian Bolte ◽  
Maria Jose Ibacache ◽  
Iris Delgado ◽  
Francisco Cano
Keyword(s):  
Peritoneal Dialysis ◽  
Left Ventricular Hypertrophy ◽  
Water Transport ◽  
Ventricular Hypertrophy ◽  
Roc Analysis ◽  
Characteristic Curve ◽  
Negative Relationship ◽  
Free Water ◽  
Inverse Correlation ◽  
Left Ventricular

BackgroundVolume overload is one of the most important factors associated with left ventricular hypertrophy (LVH) and cardiovascular disease in chronic peritoneal dialysis (PD) patients. MiniPET is a reliable tool to evaluate free water transport (FWT). In a clinical setting, the significance of FWT has not been evaluated in terms of outcome in children on PD. The objective was to define a FWT value of clinical significance in children on PD, fixing its relationship to left ventricular mass index (LVMI) as a well-known outcome parameter.MethodsMiniPET was performed with 3.86% glucose, 1-h long, to measure FWT in PD patients > 6 years old. An echocardiogram (ECG) was performed within 2 months of the MiniPET. Left ventricular hypertrophy was defined as LVMI ≥ 38.6 g/height2.7(95th percentile). Receiver operating characteristic curve (ROC) analysis was used to determine the cut-off value of FWT searching the highest sensitivity and specificity to differentiate patients with normal/abnormal LVMI. A p < 0.05 was considered significant.ResultsForty-six studies were performed on 32 patients, 16 males; mean age 11.59 ± 3.07 years. Mean normalized FWT (nFWT) was 144.4 ± 84.8 mL/m2, corresponding to 46.7% of total ultrafiltration. Mean LVMI was 42 ± 11.3 g/m2.7with a negative correlation to nFWT ( p < 0.01). Eighteen out of 32 patients had LVH. The ROC analysis (nFWT vs LVMI) showed an area under the curve of 0.71 (95% confidence interval [CI], 0.53 – 0.89; p = 0.04), allowing a cut-off nFWT value of 110 mL/m2to be defined, dividing the population into 2 groups of patients according to the LVMI cut-off value of 38,6 g/m2.7.ConclusionsThe nFWT showed an inverse correlation to LVMI. A nFWT value < 110 mL/m2was significantly associated with LVH. The negative relationship observed between nFWT and LVMI, and the cut-off level for nFWT according to the 95th percentile of LVMI, suggest that the regular evaluation of nFWT could become a useful tool in assessing the capacity of PD treatment to keep patients’ volume status under control, avoiding cardiovascular impairment.

Abstract P175: Can Pediatric Hypertension Criteria be Simplified? A Prediction Analysis of Subclinical Cardiovascular Outcomes From the Bogalusa Heart Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Bo Xi ◽  
Tao Zhang ◽  
Shengxu Li ◽  
Wei Shen ◽  
Emily Harville ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Characteristic Curve ◽  
Later Life ◽  
Left Ventricular ◽  
Pediatric Hypertension ◽  
Bogalusa Heart Study ◽  
Heart Study ◽  
Subclinical Cardiovascular Disease

Background: Pre-hypertension and hypertension in childhood are defined by sex-, age- and height-specific 90th (or ≥120/80 mmHg) and 95th percentiles of blood pressure (BP), respectively, by the 2004 Fourth Report. However, these cut-offs are complex and cumbersome for use. This study assessed the performance of a simplified BP definition to predict adult hypertension and subclinical cardiovascular disease. Methods: The longitudinal cohort consisted of 1,225 adults (530 males, aged 26.3–47.7 years) from the Bogalusa Heart Study, with 27.1 years follow-up since childhood. We used 110/70 and 120/80 mmHg for children (age 6-11 years), and 120/80 and 130/85 mmHg for adolescents (age 12-17 years) as the simplified definitions of childhood pre-hypertension and hypertension, respectively, to compare with the complex definitions. Adult carotid intima-media thickness (CIMT), pulse wave velocity (PWV), and left ventricular mass were measured using digital ultrasound instruments. High CIMT was defined as being above the age-, gender- and race-specific 80th percentile, high PWV as being above the age-, gender-, race- and heart rate-specific 80th percentile and left ventricular hypertrophy as >46.7 g/m 2.7 in women and >49.2 g/m 2.7 in men. Results: Compared to normal BP, childhood hypertensives diagnosed by the simplified definition (4.1%, 50/1,225) and the complex definition (4.8%, 59/1,225) were both at higher risk of adult hypertension with hazard ratio=3.1 (95% confidence interval=1.8-5.3) by the simplified definition and 3.2 (2.0-5.0) by the complex definition, high PWV with 3.5 (1.7-7.1) and 2.2 (1.2-4.1), high CIMT with 3.1 (1.7-5.6) and 2.0 (1.2-3.6), and left ventricular hypertrophy with 3.4 (1.7-6.8) and 3.0 (1.6-5.6). The prediction using the two childhood BP definitions for adult hypertension and subclinical cardiovascular disease was also assessed by reclassification or receiver operating characteristic curve analyses. Conclusions: The simplified childhood BP definition predicts the risk of adult hypertension and subclinical cardiovascular disease equally as the complex definition does. The simplified pediatric BP cut-offs could be easier to use for screening children at high risk and for targeting early life interventions to reduce the risk of developing cardiovascular disease in later life.

scholarly journals Defining Left Ventricular Hypertrophy in Children on Peritoneal Dialysis

2011 ◽  
Vol 6 (8) ◽  
pp. 1934-1943 ◽  
Author(s):  
Dagmara Borzych ◽  
Sevcan A. Bakkaloglu ◽  
Joshua Zaritsky ◽  
Angela Suarez ◽  
William Wong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular

scholarly journals Prognostic significance of concentric left ventricular hypertrophy at peritoneal dialysis initiation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Misato Tomura ◽  
Yoshifumi Hamasaki ◽  
Yohei Komaru ◽  
Yoshihisa Miyamoto ◽  
Ryo Matsuura ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Patient Survival ◽  
Left Ventricular ◽  
Nutrition Status ◽  
Cox Regression Analysis ◽  
Concentric Left Ventricular Hypertrophy ◽  
The Impact ◽  
The Relationship

Abstract Background Concentric left ventricular hypertrophy (cLVH) is a common left ventricular geometric pattern in patients undergoing maintenance dialysis, including peritoneal dialysis (PD). The relationship between cLVH at PD initiation and the prognosis of patients remains unclear, however. This study aimed to investigate the impact of cLVH at PD initiation on patient survival and major adverse cardiovascular events (MACE). Methods The retrospective cohort study included 131 patients who underwent echocardiography during the PD initiation period. Based on echocardiographic measurements, cLVH was defined as a condition with increased LV mass index and increased relative wall thickness. The relationship between cLVH and the prognosis was assessed. Results Concentric LVH was identified in 29 patients (22%) at PD initiation, and patient survival, MACE-free survival and PD continuation were significantly reduced in the cLVH group compared with the non-cLVH group. In the Cox regression analysis, cLVH was demonstrated as an independent risk factor of mortality (HR [95%CI]: 3.32 [1.13–9.70]) for all patients. For patients over 65 years old, cLVH was significantly associated with mortality and MACE (HR [95%CI]: 3.51 [1.06–11.58] and 2.97 [1.26–7.01], respectively). Serum albumin at PD initiation was independently correlated with cLVH. Conclusions In our study, cLVH at PD initiation was independently associated with survival in all patients and with both survival and MACE in elderly patients. Evaluation of LV geometry at PD initiation might therefore help identify high-risk patients. Further studies involving larger numbers of patients are needed to confirm the findings from this study and clarify whether treatment interventions for factors such as nutrition status could ameliorate cLVH and improve patient outcomes.

scholarly journals Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients

Pulse ◽  
2021 ◽  
pp. 1-9
Author(s):  
Masakazu Obayashi ◽  
Shigeki Kobayashi ◽  
Takuma Nanno ◽  
Yoriomi Hamada ◽  
Masafumi Yano
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Augmentation Index ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Applanation Tonometry ◽  
Central Hemodynamics ◽  
Prognostic Information ◽  
Hypertensive Patients ◽  
Significant Difference

<b><i>Introduction:</i></b> The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. <b><i>Methods:</i></b> The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21–76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54–75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. <b><i>Results:</i></b> Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (<i>r</i> = 0.602, <i>p</i> &#x3c; 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (<i>R</i><sup>2</sup> = 0.362; adjusted <i>R</i><sup>2</sup> = 0.329, <i>p</i> &#x3c; 0.001) were heart rate (β = −0.568 ± 0.149, <i>p</i> &#x3c; 0.001), central SBP (β = 0.290 ± 0.100, <i>p</i> = 0.005), and aortic root diameter (β = 1.355 ± 0.344, <i>p</i> = 0.001). Age (β = −0.025 ± 0.124, <i>p</i> = 0.841) and the central AIx (β = 0.120 ± 0.131, <i>p</i> = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI &#x3e;118 g/m<sup>2</sup> in men or &#x3e;108 g/m<sup>2</sup> in women) was statistically significant in men (0.875, <i>p</i> &#x3c; 0.001) but not in women (0.622, <i>p</i> = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. <b><i>Conclusions:</i></b> AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.

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