Abstract: FR-PO853

Significant Improvement of Left Ventricular Mass Index (LVMI) in Pediatric Patients within 6-12 Months of Initiation of Chronic Dialysis

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States
  • Geer, Jessica, Texas Children's Hospital, Houston, Texas, United States
  • Swartz, Sarah J., Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States
  • Acosta, Alisa A., None, Houston, Texas, United States
  • Shah, Shweta S., Texas Children's Hospital, Houston, Texas, United States
  • Brewer, Eileen D., Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
Background

: Left ventricular hypertrophy (LVH) determined by increased left ventricular mass indexed for index allometric height^ 2.7 (LVMI) is highly prevalent in children receiving chronic dialysis (CD). Natural history of LVH in pediatric (ped) CD patients (pts) has not been well studied; only one study showed no change in LVMI observed after 6 months of starting CD. We sought to investigate changes in LVMI from the start of CD to 6-12 months after, and its association with hypertension (HTN).

Methods

Retrospective chart review for prevalent pts at a single center treated from 2014-2017. Pts with baseline echocardiogram (ECHO) within 3 months of starting CD, who had repeat within 6-12 months while continuing CD were included. Pts were excluded if follow up ECHOs was not available or pts initiated CD at another center. Charts were reviewed for demographics and hypertension (HTN) defined by ICD diagnosis and receiving antihypertensive meds. LVH by LVMI was defined using known age and gender norms

Results

58 pts (32 male, 55%; 32 chronic HD, 55%), mean age 13.9 (range 5-19.7 years). Mean LVMI from initiation decreased significantly on follow up ECHO (initiation 56.7 ±23.7 g/m^2.7 vs. 43.7 ± 15.9 g/m^2.7, p= 0.00001), independent of CD modality or gender. 50/58 pts had HTN at CD initiation; 53/58 pts had LVH by elevated LVMI. 49/50 pts with HTN at initiation had LVH, while 4/8 normotensive pts also had LVH (exact test p=0.001). On follow up at 6-12 mon, 21/53 pts with LVH at CD initiation normalized LVMI. Only 1 pt developed new onset LVH. Uncontrolled HTN (persistent HTN and/or increased meds) was significantly associated with persistent LVH on follow up in the group who had LVH at initiation of dialysis (table).

Conclusion

Nearly all ped CD pts with HTN at initiation had LVH by LVMI. LVMI improved significantly within 6-12 mon of CD initiation. Persistent LVH was associated with uncontrolled hypertension in ped CD pts.

Change in LVH in 53 pts with LVH on CD initiation
Total n=53HTN improvedHTN not controlled
No LVH f/u ECHO183
LVH f/u ECHO1913

Exact p=0.04

Funding

  • Clinical Revenue Support