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Abstract: SA-OR42

Prevalence of Left Ventricular Hypertrophy in Pediatric Patients on Maintenance Dialysis and After Kidney Transplantation: A NAPRTCS Study

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Merrill, Kyle, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Galbiati, Shirley, EMMES, Rockville, Maryland, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Group or Team Name

  • on behalf of NAPRTCS Investigators
Background

Left ventricular hypertrophy (LVH) is recognized as the most common cardiovascular complication in children on maintenance dialysis. There have been small single-center, or cross-sectional multi-center studies but there has been no large multi-center studies looking at prevalence of LVH during long-term maintenance dialysis. Using the NAPRTCS database, we determined the prevalence of LVH at time of initiation of maintenance dialysis and changes during long-term dialysis and post kidney transplantation. We also assessed the risk factors associated with LVH in children initiating maintenance dialysis.

Methods

Echocardiographic data were obtained from the NAPRTCS database which initiated collection of echo data in 2013 with the last data obtained in March 2020. LVH was defined as left ventricular mass index (LVMI, height-indexed) >95th percentile for age and sex. Patients with cardiovascular diagnoses, those younger than 1 year old at the time of echocardiography, LVMI values >200 g/m2.7, and LVMI values based on outlying heights were excluded from analysis. Multivariable logistic regression to assess risk factors for LVH at baseline (within first 3 months after initiation of dialysis) was performed.

Results

The study cohort included 606 patients between 1 and 18 years of age (median 10y (IQR 3.8-15.1), 53% females, 48% whites, 27% African-American, and 25% others/unknown) who had LVH data during time on dialysis. Of 182 patients who had echocardiography within first 3 months after initiation of dialysis (baseline), 67% had LVH. In logistic regression, hypertension (OR 2.9, 95% CI 1.4-6.3), anemia (OR 2.8, 95% CI 1.3-6.2), and higher serum phosphorus level (OR 2.4, 95% CI 1.1-5.1) were significantly associated with the presence of LVH at baseline, while adjusting for age, race, and sex. Prevalence of LVH remained about 40-50% during long-term dialysis, with no improvement in LVH seen in patients within 6 months (47%) as well as 12 months post-transplant (43.5%), Table 1.

Conclusion

LVH remains very prevalent, difficult to control in chronically dialyzed children, and persistent after kidney transplantation.

Table 1: Percent with LVH by dialysis and transplant visit
 Baseline (0-3mo.)6 months12 months18 months24 monthsAny Time Post-DialysisPost Transplant (<6 months)Post Transplant (12 ± 3 months)
N182183169106836064946
% with LVH (95% CI)67 (59.9,73.4)51.9 (44.7,59)41.4 (34.3,49)35.8 (27.4,45.3)45.8 (35.5,56.456.4 (52.5,60.3)46.9 (33.7,60.6)43.5 (30.2, 57.8)