Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease

Abstract

A significant number of children with chronic kidney disease (CKD) have eccentric left ventricular hypertrophy (LVH), suggesting the role of preload overload. Therefore, we hypothesized that increased cardiac output (CO) might be a contributing factor for increased left ventricular mass index (LVMI) in these children. Patients aged 6–20 years with CKD stages 2–4 were enrolled. Echocardiograms were performed to assess LV function and geometry at rest and during exercise. Heart rate, stroke volume, and CO were also assessed at rest and during exercise. Twenty-four-hour ambulatory blood pressure (AMBP) monitoring was performed. Of the patients enrolled in this study, 17% had LVH. Increased stroke volume and CO were observed in patients with LVH compared to patients without LVH. Univariate analysis revealed significant positive associations between LVMI and CO, stroke volume, body mass index, pulse pressure from mean 24-h AMBP, and mean 24-h systolic BP load. No association with heart rate, age, parathyroid hormone, glomerular filtration rate, or anemia was observed. Only CO (β = 1.98, p = 0.0005) was independently associated with increased LVMI in multivariate modeling (model R 2 = 0.25). The results of this study suggest that increased CO might predispose to increased LVMI in pediatric patients with CKD. Adaptations may be required to meet increased metabolic demand in these patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Mitsnefes MM (2008) Cardiovascular complications of pediatric chronic kidney disease. Pediatr Nephrol 23:27–39

    Article  Google Scholar 

  2. 2.

    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 

  3. 3.

    Kutlay S, Dincer I, Sengul S, Nergizoglu G, Duman N, Ertuk S (2006) The long-term behavior and predictors of left ventricular hypertrophy in hemodialysis patients. Am J Kidney Dis 47:485–492

    Article  Google Scholar 

  4. 4.

    Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2006) Progression of left ventricular hypertrophy in children with early chronic kidney disease. J Pediatr 149:671–675

    Article  Google Scholar 

  5. 5.

    Mitsnefes MM, Barletta GM, Dresner IG, Chand DH, Geary D, Lin JJ, Patel H (2006) Severe cardiac hypertrophy and long-term dialysis: The midwest pediatric nephrology consortium study. Pediatr Nephrol 21:1167–1170

    Article  Google Scholar 

  6. 6.

    Zoccali C, Benedetto FA, Mallamaci F, Tripeppi G, Ciacone G, Stancanelli B, Catalioto A, Malatino LS (2004) Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int 36:286–290

    Google Scholar 

  7. 7.

    Mateucci MC, Wuhl E, Picca S, Mastrostefano A, Rinelli G, Romano C, Rizzoni G, Mehls O, de Simone G, Schaefer F, ESCAPE Trial Group (2006) Left ventricular geometry in children with mild to moderate chronic renal insufficiency. J Am Soc Nephrol 17:218–226

    Article  Google Scholar 

  8. 8.

    Levin A, Thompson CO, Ethier J, Carliste EJ, Tobe S Mendelssohn D (1999) Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 34:125–134

    CAS  Article  Google Scholar 

  9. 9.

    Stake G, Monclair T (1991) A single plasma sample method for estimation of the glomerular filtration rate in infants and children using iohexol, I: establishment of a body weight-related formula for the distribution volume of iohexol. Scand J Clin Lab Invest 51:335–342

    CAS  Article  Google Scholar 

  10. 10.

    Devereux RB, Reichec N (1977) Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 55:613–618

    CAS  Article  Google Scholar 

  11. 11.

    De Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MF, de Divitis O, Alderman MH (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

    Article  Google Scholar 

  12. 12.

    De Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH (1995) Effect of growth on variability of left ventricular mass: Assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062

    Article  Google Scholar 

  13. 13.

    Nagueh SF, Middleton KJ, Kopelan HA (1997) Doppler tissue imaging: A noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533

    CAS  Article  Google Scholar 

  14. 14.

    Ommen SR, Nishimura RA, Appleton CP (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 10:1788–1794

    Article  Google Scholar 

  15. 15.

    Colan SD, Borow KM, Neuman A (1984) Left ventricular end-systolic wall stress-velocity of fiber shortening relaxation: Preload independent index of myocardial contractility. J Am Coll Cardiol 4:715–724

    CAS  Article  Google Scholar 

  16. 16.

    James FW, Kaplan S, Glueck CJ (1980) Responses of normal children and young adults to controlled bicycle exercise. Circulation 6:902–912

    Article  Google Scholar 

  17. 17.

    Stringer WW, Hansen JE, Wasserman K (1997) Cardiac output estimated noninvasively from oxygen uptake during exercise. J Appl Physiol 82:908–912

    CAS  Article  Google Scholar 

  18. 18.

    Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2003) Left ventricular mass and systolic performance in pediatric patients with chronic renal failure. Circulation 107:864–868

    Article  Google Scholar 

  19. 19.

    Jones EC, Devereux RB, O’Grady MJ, Schwartz JE, Liu JE, Pickering TG, Roman MJ (1997) Relation of hemodynamic volume load to arterial and cardiac size. J Am Coll Cardiol 29:1303–1310

    CAS  Article  Google Scholar 

  20. 20.

    Weaver DJ Jr, Kimball TR, Knilans T, Mays W, Knecht SK, Gerdes YM, Witt S, Glascock BJ, Kartal J, Khoury P, Mitsnefes MM (2008) Decreased maximal aerobic capacity in pediatric chronic kidney disease. J Am Soc Nephrol 19:624–630

    Article  Google Scholar 

  21. 21.

    Weaver DJ Jr, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Kartal J, Mitsnefes MM (2008) Subclinical systolic dysfunction in pediatric patients with chronic kidney disease. J Pediatr 153:565–569

    Article  Google Scholar 

  22. 22.

    De Simone G, Tang W, Devereux RB, Hunt SC, Kitzman DW, Rao DC, Arnett DK (2007) Assessment of the interaction of heritability of volume load and left ventricular mass: the HyperGEN offspring study. J Hypertens 25:1397–1402

    Article  Google Scholar 

  23. 23.

    Leenen FHH, Smith DL, Unger WP (1988) Topical Minoxidil: Cardiac effects in bald men. Br J Clin Pharmacol 26:481–485

    CAS  Article  Google Scholar 

  24. 24.

    Leenen FHH, Tsoporis J (1990) Cardiac volume load as a determinant of the response of cardiac mass to anti-hypertensive therapy. Eur Heart J 11 [Suppl 6]:100–106

    Article  Google Scholar 

  25. 25.

    Ganau A, Devereux RB, Pickering TG, Roman MJ, Schnall PL, Santucci S, Spitzer MC, Laragh JH (1990) Relation of left ventricular hemodynamic load and contractile performance to left ventricular mass in hypertension. Circulation 81:25–36

    CAS  Article  Google Scholar 

  26. 26.

    Mureddu GF, Pasanisi F, Palmieri V, Celentano A, Contaldo F, De Simone G (2001) Appropriate or inappropriate left ventricular mass in the presence of absence of prognostically adverse left ventricular hypertrophy. J Hypertens 19:1113–1119

    CAS  Article  Google Scholar 

  27. 27.

    Drukteinis JS, Roman MJ, Fapsitz RR, Lee ET, Best LG, Russell M, Devereux RB (2007) Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults: The Strong Heart Study. Circulation 115:221–227

    Article  Google Scholar 

  28. 28.

    Toprak A, Wang J, Chen W, Paul T, Srinivasan S, Berenson G (2008) Relation of childhood risk factors to left ventricular hypertrophy (eccentric or concentric) in relatively young adulthood (from the Bogalusa Heart Study). Am J Cardiol 101:1621–1625

    Article  Google Scholar 

  29. 29.

    van Kesteren CA, van Heugten HA, Lamers JM, Saxena PR, Schalekamp MA, Danser AH (2005) Angiotensin II-mediated growth and anti-growth effects in cultured neonatal rat cardiac myocytes and fibroblasts. J Mol Cell Cardiol 29:2147–2157

    Article  Google Scholar 

  30. 30.

    Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500

    Article  Google Scholar 

  31. 31.

    Stenvinkel P, Ketteler M, Johnson RJ, Lindholm B, Pecoits-Filho R, Riella M, Heimburger O, Cederholm T, Girndt M (2005) IL-10, IL-6, and TNF-α: Central factors in the altered cytokine network of uremia- The good, the bad, and the ugly. Kidney Int 67:1216–1233

    CAS  Article  Google Scholar 

Download references

Acknowledgments

Research supported by grants 2K12HD28827 and K23 HL69296–01 from the National Institutes of Health (MM). This study was initially presented in abstract form at the American Society of Pediatric Nephrology Annual Meeting in May 2008.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mark M. Mitsnefes.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Weaver, D.J., Kimball, T.R., Koury, P.R. et al. Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease. Pediatr Nephrol 24, 565–570 (2009). https://doi.org/10.1007/s00467-008-1052-2

Download citation

Keywords

  • Cardiac output
  • Children
  • Chronic kidney disease
  • Left ventricular hypertrophy