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Left-ventricular diastolic dysfunction in Korean children with chronic kidney disease: data from the KNOW-Ped CKD study.
BMC Nephrol. 2020 12 09; 21(1):533.BN

Abstract

BACKGROUND

Cardiovascular disease (CVD) is the most common cause of mortality in pediatric chronic kidney disease (CKD) patients. Left ventricular (LV) hypertrophy (LVH) is associated with LV diastolic dysfunction (LVDD) development and is used as an early marker of CVD in pediatric CKD. This study aimed to assess the prevalence and risk factors of LVDD and the association between LVH and LVDD in Korean pediatric CKD patients.

METHODS

Data were collected using the baseline data of the Korean cohort study for outcome in patients with pediatric chronic kidney disease, a nationwide, 10-year, prospective, observational cohort study of pediatric CKD. A total of 244 patients were included in the final analysis. Two-dimensional echocardiography and tissue Doppler images were used to evaluate LVH and LVDD. LVH was defined as an LV mass index (LVMI) ≥38 g/m2.7 and LV-wall thickness z-score > 1.64. LVDD was defined as a mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E') > 14. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors of LVDD.

RESULTS

In this study, the male-to-female ratio was 2.2 (168:76) and median age was 11.2 years. The average estimated glomerular filtration rate was 57.4 ml/min/1.73 m2, and no patients received renal replacement therapy. The mean value of LVMI and E/E' was 37.0 g/m2.7 and 7.4, respectively. The prevalence of LVH was 40.1 and 17.4% by LVMI ≥38 g/m2.7 and LV-wall thickness z-score, respectively. The prevalence of LVDD was 4.5%, and patients with LVH showed greater risk of LVDD (odds ratio 7.3, p = 0.012). In the univariate analysis, young age, low hemoglobin level, higher LVMI, and higher LV-wall thickness z-score were associated with LVDD. In the multivariate analysis, young age, low hemoglobin level, and higher LV-wall thickness z-score were independently associated with LVDD.

CONCLUSION

This study shows that LVH patients have a greater risk of LVDD and that anemia is the only modifiable risk factor for LVDD in Korean pediatric CKD patients.

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Authors+Show Affiliations

Kim JY
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Lee Y
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Kang HG
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
Ha IS
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
Cheong HI
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
Choi HJ
National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungcheongbuk-do, South Korea.
Han KH
Department of Pediatrics, Jeju University Hospital, Jeju, South Korea.
Kim SH
Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea.
Cho MH
Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, South Korea.
Shin JI
Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, South Korea.
Lee JH
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea.
Park YS
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea.
Cho H
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. choheeyeon@gmail.com.

MeSH

AdolescentAnemiaAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsChildChild, PreschoolCohort StudiesDiastoleFemaleGlomerular Filtration RateHumansHypertrophy, Left VentricularInfantLogistic ModelsMaleMultivariate AnalysisProspective StudiesRenal Insufficiency, ChronicRepublic of KoreaRisk FactorsVentricular Dysfunction, Left

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33297989

Citation

Kim, Jeong Yeon, et al. "Left-ventricular Diastolic Dysfunction in Korean Children With Chronic Kidney Disease: Data From the KNOW-Ped CKD Study." BMC Nephrology, vol. 21, no. 1, 2020, p. 533.
Kim JY, Lee Y, Kang HG, et al. Left-ventricular diastolic dysfunction in Korean children with chronic kidney disease: data from the KNOW-Ped CKD study. BMC Nephrol. 2020;21(1):533.
Kim, J. Y., Lee, Y., Kang, H. G., Ha, I. S., Cheong, H. I., Choi, H. J., Han, K. H., Kim, S. H., Cho, M. H., Shin, J. I., Lee, J. H., Park, Y. S., & Cho, H. (2020). Left-ventricular diastolic dysfunction in Korean children with chronic kidney disease: data from the KNOW-Ped CKD study. BMC Nephrology, 21(1), 533. https://doi.org/10.1186/s12882-020-02152-6
Kim JY, et al. Left-ventricular Diastolic Dysfunction in Korean Children With Chronic Kidney Disease: Data From the KNOW-Ped CKD Study. BMC Nephrol. 2020 12 9;21(1):533. PubMed PMID: 33297989.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left-ventricular diastolic dysfunction in Korean children with chronic kidney disease: data from the KNOW-Ped CKD study. AU - Kim,Jeong Yeon, AU - Lee,Yeonhee, AU - Kang,Hee Gyung, AU - Ha,Il-Soo, AU - Cheong,Hae Il, AU - Choi,Hyun Jin, AU - Han,Kyoung Hee, AU - Kim,Seong Heon, AU - Cho,Min Hyun, AU - Shin,Jae Il, AU - Lee,Joo Hoon, AU - Park,Young Seo, AU - Cho,Heeyeon, Y1 - 2020/12/09/ PY - 2020/06/01/received PY - 2020/11/04/accepted PY - 2020/12/10/entrez PY - 2020/12/11/pubmed PY - 2021/9/3/medline KW - Children KW - Chronic kidney disease KW - Left ventricular diastolic dysfunction SP - 533 EP - 533 JF - BMC nephrology JO - BMC Nephrol VL - 21 IS - 1 N2 - BACKGROUND: Cardiovascular disease (CVD) is the most common cause of mortality in pediatric chronic kidney disease (CKD) patients. Left ventricular (LV) hypertrophy (LVH) is associated with LV diastolic dysfunction (LVDD) development and is used as an early marker of CVD in pediatric CKD. This study aimed to assess the prevalence and risk factors of LVDD and the association between LVH and LVDD in Korean pediatric CKD patients. METHODS: Data were collected using the baseline data of the Korean cohort study for outcome in patients with pediatric chronic kidney disease, a nationwide, 10-year, prospective, observational cohort study of pediatric CKD. A total of 244 patients were included in the final analysis. Two-dimensional echocardiography and tissue Doppler images were used to evaluate LVH and LVDD. LVH was defined as an LV mass index (LVMI) ≥38 g/m2.7 and LV-wall thickness z-score > 1.64. LVDD was defined as a mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E') > 14. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors of LVDD. RESULTS: In this study, the male-to-female ratio was 2.2 (168:76) and median age was 11.2 years. The average estimated glomerular filtration rate was 57.4 ml/min/1.73 m2, and no patients received renal replacement therapy. The mean value of LVMI and E/E' was 37.0 g/m2.7 and 7.4, respectively. The prevalence of LVH was 40.1 and 17.4% by LVMI ≥38 g/m2.7 and LV-wall thickness z-score, respectively. The prevalence of LVDD was 4.5%, and patients with LVH showed greater risk of LVDD (odds ratio 7.3, p = 0.012). In the univariate analysis, young age, low hemoglobin level, higher LVMI, and higher LV-wall thickness z-score were associated with LVDD. In the multivariate analysis, young age, low hemoglobin level, and higher LV-wall thickness z-score were independently associated with LVDD. CONCLUSION: This study shows that LVH patients have a greater risk of LVDD and that anemia is the only modifiable risk factor for LVDD in Korean pediatric CKD patients. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/33297989/Left_ventricular_diastolic_dysfunction_in_Korean_children_with_chronic_kidney_disease:_data_from_the_KNOW_Ped_CKD_study_ DB - PRIME DP - Unbound Medicine ER -