Left ventricular strain in pediatric patients with end-stage renal disease

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

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Infections in Pediatric Patients with End-Stage Renal Disease

Healthcare-Associated Infections in Children ◽

10.1007/978-3-319-98122-2_18 ◽

2018 ◽

pp. 323-343

Author(s):

Ayse Akcan-Arikan ◽

Sarah J. Swartz ◽

Poyyapakkam R. Srivaths

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Pediatric Patients ◽

Stage Renal Disease ◽

End Stage

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Assessment of left ventricular mass changes after arteriovenous fistula surgical banding in end-stage renal disease

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.248299 ◽

2018 ◽

Vol 29 (6) ◽

pp. 1280

Author(s):

JuanC Duque ◽

Camilo Cortesi ◽

Sedki Mai ◽

Laisel Martinez ◽

Adriana Dejman ◽

...

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

Left Ventricular Mass ◽

End Stage Renal Disease ◽

Left Ventricular ◽

Ventricular Mass ◽

Stage Renal Disease ◽

End Stage

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Abstract 17623: A Case of Biopsy-proven Immunoglobulin G4-Related Disease Associated With Multiple Giant Coronary Artery Aneurysms, Peripheral Arterial Aneurysms, End Stage Renal Disease, and Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.17623 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Mark D Benson ◽

Cathryn Byrne-Dugan ◽

Dale Adler ◽

Mark Feinberg ◽

Deepak Bhatt

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Renal Disease ◽

End Stage Renal Disease ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Arterial Disease ◽

Related Disease ◽

Stage Renal Disease ◽

End Stage

A 54-year-old man with remote large cell non-Hodgkin’s lymphoma in remission following R-CHOP and severe atopic dermatitis was transferred from another hospital with a non-ST elevation myocardial infarction. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly depressed left ventricular ejection fraction (LVEF) of 20% by echocardiography and rapidly progressive end-stage renal disease of unclear etiology requiring the initiation of hemodialysis. Prior workup had demonstrated an infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms with subsequent computed tomography (CT) additionally demonstrating a superior mesenteric artery aneurysm. The patient was taken for immediate coronary arteriography, which demonstrated giant aneurysms in the left main and right coronary arteries, as well as multivessel severe stenoses. CT coronary angiogram demonstrated significant circumferential wall thickening throughout the coronary vasculature. Given concern for IgG4-related disease (IgG4-RD), a renal biopsy was pursued that confirmed the diagnosis. 18F-fluorodeoxyglucose positron emission tomography-CT identified only mild aortic inflammation. The patient was treated with high-dose steroids and rituximab. The serological inflammatory markers improved, and he underwent coronary artery bypass grafting. Pericardial, aortic adventitial, left internal mammary artery, and saphenous vein biopsies showed cardiovascular involvement of IgG4-RD. The patient has been maintained on rituximab with normalization of his LVEF and no recurrence of chest pain over the past eighteen months. IgG4-RD is a fibroinflammatory systemic disease newly described in 2003 and only recently found to involve the cardiovascular system with several reports of peripheral aneurysmal disease. To our knowledge, the current case represents the first report of a patient successfully treated for biopsy-proven IgG4-RD associated with coronary artery disease and left ventricular systolic dysfunction. IgG4-RD may represent a novel mechanism underlying some forms of peripheral and coronary arterial disease and may offer new insights into vascular biology.

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Causes of Increased Renal Echogenicity in Pediatric Patients

PEDIATRICS ◽

10.1542/peds.72.6.840 ◽

1983 ◽

Vol 72 (6) ◽

pp. 840-846

Author(s):

Alan M. Krensky ◽

Joseph M. Reddish ◽

Rita Littlewood Teele

Keyword(s):

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Pediatric Patients ◽

Renal Diseases ◽

Polycystic Kidney ◽

Renal Size ◽

Stage Renal Disease ◽

End Stage ◽

Echogenic Kidneys

Review of 2,700 abdominal ultrasonic examinations revealed 56 patients whose kidneys showed increased echogenicity. Echogenic kidneys were associated with medical renal disease in 94% of cases (30% glomerular, 48% tubulointerstitial, 16% end-stage) and with no detectable renal disease in 6% (three patients). Patterns of increased echogenicity and renal size were evaluated. Specific patterns occurred in end-stage renal disease and polycystic kidney disease. Other medical renal diseases had overlapping ultrasonographic features. Some generalizations could be made although increased echogenicity was often nonspecific.

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Effect of Ultrafiltration on Sleep Apnea and Cardiac Function in End-Stage Renal Disease

American Journal of Nephrology ◽

10.1159/000505445 ◽

2020 ◽

Vol 51 (2) ◽

pp. 139-146 ◽

Cited By ~ 2

Author(s):

Toru Inami ◽

Owen D. Lyons ◽

Elisa Perger ◽

Azadeh Yadollahi ◽

John S. Floras ◽

...

Keyword(s):

Sleep Apnea ◽

Renal Disease ◽

Cardiac Function ◽

End Stage Renal Disease ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Systolic And Diastolic Function ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

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