Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study.
OBJECTIVE
To determine the prevalence and incidence of left ventricular hypertrophy (LVH) and LV geometry and identify variables associated with LV mass (LVM) growth and development of LVH in children and adolescents with chronic kidney disease (CKD).


METHODS
A 2-year longitudinal study of children with CKD (glomerular filtration rate [GFR] 15-89 mL/minute/1.73 m2). Thirty-one subjects had baseline and repeated echocardiography.


RESULTS
Six (19%) of 31 children had LVH at baseline; the prevalence of LVH increased to 39% at 2-year follow-up. Eccentric LVH was the most common geometric pattern throughout the study. Among 25 children with initially normal LVM index, 8 (32%) developed new LVH. Children with incident LVH had significantly higher mean parathyroid hormone (iPTH), lower hemoglobin and calcium levels at baseline, and significantly larger increase in iPTH during a follow-up than children with normal LVM index. Stepwise regression analysis showed that lower initial LVM index and hemoglobin level and interval increase in iPTH and nighttime systolic blood pressure (SBP) load during a follow-up independently predicted interval increase in LVM index.


CONCLUSIONS
LVH progresses in children during early stages of CKD. More aggressive control of anemia, BP, and hyperparathyroidism might be important in preventing the development of LVH in these patients.
Mitsnefes
Mark M
MM
Division of Nephrology and Hypertension and the Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. mark.mitsnefes@cchmc.org
Kimball
Thomas R
TR
Kartal
Janis
J
Witt
Sandra A
SA
Glascock
Betty J
BJ
Khoury
Philip R
PR
Daniels
Stephen R
SR
D000293:Adolescent; D000328:Adult; D016275:Atrial Function; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002648:Child; D002940:Circadian Rhythm; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
D015415:Biomarkers