Improved left ventricular mass index in children after renal transplantation

Pediatric Nephrology volume 23, pages1545–1550(2008)Cite this article

Abstract

Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease, and it is prevalent in children with end-stage renal disease (ESRD) and after renal transplantation (RTx) on cross-sectional studies. Our aim was to compare prospectively left ventricular mass index (LVMI) in children with ESRD, before and after RTx. Thirteen patients aged 1.5–15 years underwent echocardiogram prior to and at least 3 months after RTx, and again in the second year after transplantation. A control group consisted of children with ESRD who remained on dialysis. Systolic and diastolic blood pressure index decreased significantly over the study period only in the children who had undergone RTx. Mean LVMI in children with ESRD decreased from 45.4 ± 12.6 g/m2.7 to 34.9 ± 10.4 g/m2.7 after RTx (P = 0.001), but it remained unchanged in patients who remained on dialysis. The prevalence of LVH decreased from 54% to 8% (P = 0.03) after RTx. Systolic and diastolic blood pressure index were correlated with LVMI. Mean body mass index increased during the study period from 17.3 ± 2.5 to 20 ± 4.6 (P = 0.05); however, no correlation was found with LVMI. LVH in children with ESRD is potentially reversible after RTx, especially with good control of hypertension.

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References

  1. 1.

    McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662

    CAS  Article  Google Scholar 

  2. 2.

    United States Renal Data System (2001) Excerpts from the USRDS 2001 annual report. Am J Kidney Dis 38 [Suppl 3]:S147–S158

    Google Scholar 

  3. 3.

    Middleton RJ, Parfrey PS, Foley RN (2001) Left ventricular hypertrophy in the renal patient. J Am Soc Nephrol 12:1079–1084

    CAS  PubMed  Google Scholar 

  4. 4.

    Becker-Cohen R, Nir A, Rinat C, Feinstein S, Algur N, Farber B, Frishberg Y (2006) Risk factors for cardiovascular disease in children and young adults after renal transplantation. Clin J Am Soc Nephrol 1:1284–1292

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    El-Husseini AA, Sheashaa HA, Hassan NA, El-Demerdash FM, Sobh MA, Ghoneim MA (2004) Echocardiographic changes and risk factors for left ventricular hypertrophy in children and adolescents after renal transplantation. Pediatr Transplant 8:249–254

    Article  Google Scholar 

  6. 6.

    Matteuci MG, Giordano U, Calzolari A, Turchetta A, Santillli A, Rizzoni G (1999) Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients. Kidney Int 56:1566–1570

    Article  Google Scholar 

  7. 7.

    Kitzmueller E, Vecsei A, Pichler J, Bohm M, Muller T, Vargha R, Csaicsich D, Aufricht C (2004) Changes of blood pressure and left ventricular mass in pediatric renal transplantation. Pediatr Nephrol 19:1385–1389

    Article  Google Scholar 

  8. 8.

    Mitsnefes MM, Kimball TR, Border WL, Witt SA, Glassock BJ, Khoury PR, Daniels SR (2004) Abnormal cardiac function in children after renal transplantation. Am J Kidney Dis 43:721–726

    Article  Google Scholar 

  9. 9.

    Kessler M, Zannad F, Lehert P, Grunfeld JP, Thuilliez C, Leizorovicz A, Lechat P, FOSIDIAL investigators (2007) Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the Fosinopril in Dialysis study. Nephrol Dial Transplant 22:3573–3579

    Article  Google Scholar 

  10. 10.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  11. 11.

    DeSimone G, Daniels SR, Devereux RB, Koren MJ, Meye RA, Laragh JH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260

    CAS  Article  Google Scholar 

  12. 12.

    Khoury PR, Daniels SR, Gidding SS, Kimball TR (2004) Left ventricular mass index in children: what is the right index? J Am Soc Echocardiogr 17:555

    Google Scholar 

  13. 13.

    Paoletti E, Cassottana P, Amidone M, Gherzi M, Rolla D, Cannella G (2007) ACE inhibitors and persistent left ventricular hypertrophy after renal transplantation: a randomized clinical trial. Am J Kidney Dis 50:133–142

    CAS  Article  Google Scholar 

  14. 14.

    Ferreira SR, Moises VA, Tavares A, Pacheo-Silva A (2002) Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation 74:1580–1587

    Article  Google Scholar 

  15. 15.

    Hernandez D, Lacalzada J, Salido E, Linares J, Barragan A, Lorenzo V, Higueras L, Martin B, Rodríguez A, Laynez I, Gonzalez-Posada JM, Torres A (2000) Regression of left ventricular hypertrophy by lisinopril after renal transplantation: role of ACE gene polymorphism. Kidney Int 58:889–897

    CAS  Article  Google Scholar 

  16. 16.

    Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR (1996) Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 50:998–1006

    CAS  Article  Google Scholar 

  17. 17.

    Mitsnefes MM, Schwartz SM, Daniels SR, Kimball TR, Khoury P, Strife CF (2001) Changes in left ventricular mass index in children and adolescents after renal transplantation. Pediatr Transplant 5:279–284

    CAS  Article  Google Scholar 

  18. 18.

    Kennedy DJ, Malhotra D, Shapiro JI (2006) Molecular insights into uremic cardiomyopathy: cardiotonic steroids and Na/K ATPase signaling. Cell Mol Biol 52:3–14

    CAS  PubMed  Google Scholar 

  19. 19.

    Espino G, Denney J, Furlong T, Fitzsimmons W, Nash RA (2001) Assessment of myocardial hypertrophy by echocardiography in adult patients receiving tacrolimus or cyclosporine therapy for prevention of acute GVHD. Bone Marrow Transplant 28:1097–1103

    CAS  Article  Google Scholar 

  20. 20.

    Radermacher J, Meiners M, Bramlage C, Kilem V, Behrend M, Schlitt HJ, Pichlmayr R, Koch KM, Brunkhorst R (1998) Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporine A versus FK 506. Transpl Int 11:3–10

    CAS  Article  Google Scholar 

  21. 21.

    Ji SM, Li LS, Sha GZ, Chen JS, Liu ZH (2007) Conversion from cyclosporine to tacrolimus for chronic allograft nephrology. Transplant Proc 39:1402–1405

    CAS  Article  Google Scholar 

  22. 22.

    Pappas PA, Weppler D, Pinna AD, Rusconi P, Thompson JF, Jaffe JS, Tzakis AG (2000) Sirolimus in pediatric gastrointestinal transplantation: the use of sirolimus for pediatric transplant patients with tacrolimus-related cardiomyopathy. Pediatr Transplant 4:45–49

    CAS  Article  Google Scholar 

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Affiliations

  1. Division of Pediatric Nephrology, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, Israel, 91031

    Rachel Becker-Cohen, Efrat Ben-Shalom, Choni Rinat, Sofia Feinstein & Yaacov Frishberg

  2. The Hadassah Hebrew University School of Medicine, Jerusalem, Israel

    Rachel Becker-Cohen, Amiram Nir, Efrat Ben-Shalom, Choni Rinat, Sofia Feinstein, Benjamin Farber & Yaacov Frishberg

  3. Division of Pediatric Cardiology, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, Israel, 91031

    Amiram Nir & Benjamin Farber

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  1. Rachel Becker-Cohen
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  2. Amiram Nir
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  3. Efrat Ben-Shalom
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  4. Choni Rinat
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  5. Sofia Feinstein
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  6. Benjamin Farber
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  7. Yaacov Frishberg
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Correspondence to Rachel Becker-Cohen.

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Becker-Cohen, R., Nir, A., Ben-Shalom, E. et al. Improved left ventricular mass index in children after renal transplantation. Pediatr Nephrol 23, 1545–1550 (2008). https://doi.org/10.1007/s00467-008-0855-5

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Keywords

  • Left ventricular hypertrophy
  • Hypertension
  • Renal transplantation
  • Pediatric