title: Diagnosis of cardiac disease in pediatric end-stage renal disease.
abstract: BACKGROUND
  Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). This study aimed to report the frequency of cardiac disease diagnostic methods used in US pediatric maintenance hemodialysis patients.
  
  
  METHODS
  A cross-sectional analysis of all US pediatric (ages 0.7-18 years, n = 656) maintenance hemodialysis patients was performed using data from the Centers for Medicare and Medicaid Services ESRD Clinical Performance Measures Project. Clinical and laboratory information was collected in 2001. Results were analysed by age, sex, race, Hispanic ethnicity, dialysis duration, body mass index (BMI), primary ESRD cause and laboratory data.
  
  
  RESULTS
  Ninety-two percent of the patients had a cardiovascular risk factor (63% hypertension, 38% anemia, 11% BMI > 94th percentile, 63% serum phosphorus > 5.5 mg/dL and 55% calcium-phosphorus product ≥ 55 mg(2)/dL(2)). A diagnosis of cardiac disease was reported in 24% (n = 155) of all patients: left ventricular hypertrophy/enlargement 17%, congestive heart failure/pulmonary edema 8%, cardiomyopathy 2% and decreased left ventricular function 2%. Thirty-one percent of patients were not tested. Of those tested, the diagnostic methods used were chest X-rays in 60%, echocardiograms in 35% and electrocardiograms in 33%; left ventricular hypertrophy/enlargement was diagnosed using echocardiogram (72%), chest X-ray (20%) and electrocardiogram (15%).
  
  
  CONCLUSIONS
  Although 92% of patients had cardiovascular risk factors, an echocardiography was performed in only one-third of the patients. Our study raises the question of why echocardiography, considered the gold standard for cardiac disease diagnosis, has been infrequently used in pediatric maintenance dialysis patients, a high-risk patient population.
authors.affiliation: Department of Pediatrics University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN, USA. chave001@umn.edu
authors.forename: Blanche M
authors.initials: BM
authors.lastname: Chavers
authors.forename: Craig A
authors.initials: CA
authors.lastname: Solid
authors.forename: Alan
authors.initials: A
authors.lastname: Sinaiko
authors.forename: Frank X
authors.initials: FX
authors.lastname: Daniels
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: Diane L
authors.initials: DL
authors.lastname: Frankenfield
authors.forename: Charles A
authors.initials: CA
authors.lastname: Herzog
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate