Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors

Left ventricular hypertrophy (LVH) has been recognized as an independent ri sk factor for cardiovascular morbidity and mortality in adults with end-sta ge renal disease. However the prevalence and severity of LVH in children on chronic dialysis therapy is not well established. Retrospectively, 64 chro nic dialysis patients, aged 20 months to 22 years, on chronic dialysis had echocardiographic evaluation of LV mass (LVM) and geometry. Forty-eight (75 %) children had LVH, including 22 of 26 (85%) on hemodialysis (KD) and 26 o f 38 (68%) on peritoneal dialysis (PD). The prevalence of LVH in patients o n HD was significantly higher than those on PD (P=0.02). Abnormal LV geomet ry was found in 51 of 64 (80%) patients: 25 patients (39%) had eccentric hy pertrophy, 3 (5%) had concentric remodelling, and 23 (36%) had concentric L VH. Twenty-six children (41%) had severe LVH, defined as LVM index greater than 51 g/m(2.7), which is associated with a fourfold greater risk for deve lopment of cardiovascular disease in adults. Patients with severe LVH had a significantly lower hemoglobin level (P=0.027) and longer duration of rena l disease prior to the start of dialysis therapy (P=0.003) than patients wi thout LVH. Multiple logistic regression analysis revealed HD as opposed to PD as a significant independent predictor for severe LVH (P=0.036). Higher systolic blood pressure remained in the final model as an independent predi ctor with a borderline level of significance (P=0.065). The results indicat e that severe LVH and abnormal left ventricular geometry are common in youn g dialysis patients. Better control of blood pressure, anemia, and hypervol emia may be important in prevention or improving LVH.