title: Left ventricular geometry in children with mild to moderate chronic renal insufficiency.
abstract: Left ventricular hypertrophy (LVH) is the most important independent marker of cardiovascular risk in adults with chronic kidney disease. Cardiovascular morbidity seems increased even in children with chronic renal insufficiency (CRI), but the age and stage of CRI when cardiac alterations become manifest are unknown. For assessing the prevalence and factors associated with abnormal LV geometry in children with CRI, echocardiograms, ambulatory BP monitoring, and biochemical profiles were obtained in 156 children aged 3 to 18 yr with stages 2 through 4 chronic kidney disease (GFR 49 +/- 19 ml/min per 1.73 m2) and compared with echocardiograms obtained in 133 healthy children of comparable age and gender. LV mass was indexed to height2.7. Concentric LV remodeling was observed in 10.2%, concentric LVH in 12.1%, and eccentric LVH in 21% of patients. LVH was more common in boys (43.3 versus 19.4%; P < 0.005). Probability of LVH independently increased with male gender (odds ratio [OR] 2.62; P < 0.05) and standardized body mass index (OR 1.56; P = 0.01). Low hemoglobin, low GFR, young age, and high body mass index were independent correlates of LV mass index (0.005 < P < 0.05). LV concentricity (relative wall thickness) was positively associated with serum albumin (P < 0.05). Probability of abnormal LV geometry increased with C-reactive protein >10 mg/dl (OR 26; P < 0.001). In conclusion, substantial cardiac remodeling of both concentric and eccentric type is present at young age and early stages of CRI in children. Prevalence of LVH is related to male gender, anemia, and ponderosity but not to BP. Additional effects of volume status and inflammation on cardiac geometry are also evident.
authors.affiliation: Division of Pediatric Nephrology, Bambino Gesú, Hospital, Rome, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Matteucci
authors.forename: Elke
authors.initials: E
authors.lastname: Wühl
authors.forename: Stefano
authors.initials: S
authors.lastname: Picca
authors.forename: Antonio
authors.initials: A
authors.lastname: Mastrostefano
authors.forename: Gabriele
authors.initials: G
authors.lastname: Rinelli
authors.forename: Carmela
authors.initials: C
authors.lastname: Romano
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Rizzoni
authors.forename: Otto
authors.initials: O
authors.lastname: Mehls
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors