title: Serum cystatin C and left ventricular diastolic dysfunction in children with chronic kidney disease.
abstract: Previous studies indicate that serum cystatin C predicts incident heart failure in older adults. Children with chronic kidney disease (CKD) develop left ventricular (LV) diastolic dysfunction, often the initial abnormality of cardiac function. We hypothesized that cystatin C might predict LV diastolic dysfunction in children with CKD. Fifty-seven subjects, aged 6-21 years, with stage 2-4 CKD underwent echocardiography. Diastole was assessed from transmitral Doppler [maximum early (E wave) and late (A wave) diastolic flow velocities (E/A ratio)] and from tissue Doppler [septal mitral annular peak velocities (E')]. LV filling pressures were determined, using a ratio of E/E'. Fourteen (25%) patients had low E' and 15 (26%) had high E/E'. Children with abnormal E' or E/E' had significantly higher cystatin C levels than children with normal indices (P<0.05). Neither serum creatinine nor measured glomerular filtration rate (GFR) significantly correlated with E' or E/E'. Stepwise multiple regression analysis showed that cystatin C (beta=-0.825, P=0.023) and left ventricular mass (LVM) index (beta=0.099, P=0.006) independently predicted E'; LVM index independently predicted E/E' (beta=0.0173, P=0.01). We conclude that, in contrast to measured GFR or serum creatinine level, elevated serum cystatin C might be associated with diastolic dysfunction in children with CKD.
authors.affiliation: Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati, MLC 7022, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA. mark.mitsnefes@cchmc.org
authors.forename: Mark
authors.initials: M
authors.lastname: Mitsnefes
authors.forename: Thomas
authors.initials: T
authors.lastname: Kimbal
authors.forename: Janis
authors.initials: J
authors.lastname: Kartal
authors.forename: Thelma
authors.initials: T
authors.lastname: Kathman
authors.forename: Jaya
authors.initials: J
authors.lastname: Mishra
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000503:physiopathology; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000503:physiopathology
chemical_list: C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins