Changes in left ventricular mass in children and adolescents during chronic dialysis

Left ventricular hypertrophy (LVH) is an independent risk factor for cardia c mortality in adults with end-stage renal disease (ESRD). It is prevalent in pediatric patients on chronic dialysis. The objectives of this study wer e to evaluate left ventricular mass (LVM) in children and adolescents at th e initiation of dialysis and to assess its changes during chronic dialysis therapy. In this longitudinal analysis, 29 patients aged 4-18 years had an echocardiographic evaluation within 90 days of starting dialysis therapy an d a follow-up study at least 6 months later. LVH was defined as LVM index ( g/m(2.7)) > 95th percentile for normal children and adolescents. On the ini tial echocardiogram 20 of 29 (69%) patients had LVH and 24 patients (83%) h ad abnormal LV geometry (38% eccentric LVH, 31% concentric LVH, and 14% con centric remodelling). Patients with LVH were more likely to be on antihyper tensive medications (16/20) than patients without LVH (3/9) (P=0.005). Repe at echocardiogram, performed after 10 +/-3 months on chronic dialysis, show ed no significant difference in the mean LVM index (49.6 +/- 17.5 g/m(2.7) and 49.7 +/- 16.1 g/m(2.7), respectively) or in the prevalence of LVH or LV geometric pattern. However, 14 of 29 patients had a progressive increase i n LVM index and 15 patients had regression. Multiple regression analysis sh owed that baseline LVM index (P=0.005) and interval change in indexed systo lic blood pressure (P=0.027) were independent predictors for LVM index chan ges. In summary, LVH and abnormal LV geometry are already prevalent in chil dren and adolescents with renal failure at the time of initiation of dialys is therapy, indicating that LVH develops during the pre-ESRD course. Early intervention to control blood pressure may be an important factor to improv e and prevent progression of LVH in pediatric patients with ESRD.