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.
Similar content being viewed by others
References
Mitsnefes MM (2008) Cardiovascular complications of pediatric chronic kidney disease. Pediatr Nephrol 23:27–39
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
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
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
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
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
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
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
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
Devereux RB, Reichec N (1977) Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 55:613–618
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
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
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
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
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
James FW, Kaplan S, Glueck CJ (1980) Responses of normal children and young adults to controlled bicycle exercise. Circulation 6:902–912
Stringer WW, Hansen JE, Wasserman K (1997) Cardiac output estimated noninvasively from oxygen uptake during exercise. J Appl Physiol 82:908–912
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
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
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
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
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
Leenen FHH, Smith DL, Unger WP (1988) Topical Minoxidil: Cardiac effects in bald men. Br J Clin Pharmacol 26:481–485
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
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
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
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
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
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
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
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
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
Authors and Affiliations
Corresponding author
Rights 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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-008-1052-2