CARDIAC ABNORMALITIES IN END-STAGE RENAL-FAILURE AND ANEMIA

Thirteen anaemic children on dialysis were assessed to determine the i ncidence of cardiac changes in end stage renal failure. Nine children had an increased cardiothoracic ratio on radiography. The electrocardi ogram was abnormal in every case but no child had left ventricular hyp ertrophy as assessed by voltage criteria. However, left ventricular hy pertrophy, often gross, was found on echocardiography in 12 children a nd affected the interventricular septum disproportionately. Cardiac in dex was increased in 10 patients as a result of an increased left vent ricular stroke volume rather than heart rate. Left ventricular hypertr ophy was significantly greater in those on treatment for hypertension and in those with the highest cardiac index. Abnormal diastolic ventri cular function was found in 6/11 children. Children with end stage ren al failure have significant cardiac adnormalities that are likely to c ontribute to the high cardiovascular mortality in this group. Anaemia and hypertension, or its treatment, probably contribute to these chang es. Voltage criteria on electrocardiogram are of no value in detecting left ventricular hypertrophy. Echocardiography must be performed, wit h the results corrected for age and surface area, in order to detect a nd follow these abnormalities.