Abstract: FR-PO1140
Left Ventricular Mass Index (LVMI) Improves with Resolution of Hypertension in Incident Pediatric Hemodialysis Patients
Session Information
- Pediatric Nephrology - I
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1600 Pediatric Nephrology
Authors
- Shah, Shweta S., Texas Children's Hospital, Houston, Texas, United States
- Acosta, Alisa A., Texas Children's Hospital, Houston, Texas, United States
- Swartz, Sarah J., Texas Children's Hospital, Houston, Texas, United States
- Geer, Jessica, Texas Children's Hospital, Houston, Texas, United States
- Juarez, Marisa D., Texas Children's Hospital, Houston, Texas, United States
- Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States
Background
Left ventricular hypertrophy (LVH), determined by increased left ventricular mass indexed for allometric height^ 2.7 (LVMI), is highly prevalent in children receiving chronic dialysis (CD). Natural history of LVH in pediatric (ped) CD patients (pts) is not well known; one study showed no change in LVMI after 6 months of starting CD. We have shown LVMI improves with control of HTN in CD patients. For this study, the aim was to investigate the relationship of fluid overload (FO) and HTN with LVMI in incident HD patients.
Methods
Retrospective chart review from a single center to identify pts starting HD from 2012-2017. Pts with echocardiogram (ECHO) within 3 months of starting HD and repeat ECHO in 6-12 months while continuing HD were included. Pts were excluded if follow up ECHO was not available or pts initiated CD at another center and initial ECHO not available. Charts reviewed for demographics, relevant labs, hypertension (HTN) defined by treatment with antihypertensive meds; FO as identified by % above dry wt; LVMI was converted to percentiles based on published normative values for age and gender.
Results
43 pts (22 male), mean age 13.1 (range 3-17.41 years); 38/43 pts who had HTN at HD initiation also had increased LVMI (96.6 ± 8.09%tile vs. 81.25 ± 12.5%tile). Mean LVMI from initiation decreased significantly on follow up ECHO (initiation 94.7 ± 9.94 %tile vs. 81.13 ± 24.8%tile, p= 0.0006), independent of age or gender. Those who had resolution of HTN had improved LVMI, while those with continued HTN did not improve LVMI (Table). Pts in our study had only minimal FO over the 6-12 month period: (3.6 ± 1.2 %, range 1.25% -6.54%). FO was not associated with LVMI change (mixed effects model p=0.2). Hgb, phosphorus, calcium or PTH were also not associated with LVMI change.
Conclusion
Ped HD pts with HTN at initiation had elevated LVMI. LVMI improved significantly within 6-12 months of HD initiation. Hypertension resolution was associated with improvement of LVMI. In our population of pts with tight fluid control, FO was not associated with change in LVMI.
| 43 patients total | HTN resolved*(26) | HTN persisted** (17) |
| LVMI%tile at start | 95 ± 9.4 | 96±10.7 |
| LVMI%tile after 6-12 months | 79 ± 26.6 | 90 ± 17.2 |
*p=0.003, ** NS; paired t test