title: Cardiac geometry in children receiving chronic peritoneal dialysis: findings from the International Pediatric Peritoneal Dialysis Network (IPPN) registry.
abstract: OBJECTIVE
  Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow-up in dialyzed children.
  
  
  METHODS
  Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95(th) percentile of LV mass index relative to height age was used to define LVH.
  
  
  RESULTS
  The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia.
  
  
  CONCLUSIONS
  Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH.
authors: Gazi University Department of Pediatric Nephrology, Besevler, Ankara, 06500 Turkey. sevcan@gazi.edu.tr
authors: Sevcan A
authors: SA
authors: Bakkaloglu
authors: Dagmara
authors: D
authors: Borzych
authors: Il
authors: I
authors: Soo Ha
authors: Erkin
authors: E
authors: Serdaroglu
authors: Rainer
authors: R
authors: Büscher
authors: Paulina
authors: P
authors: Salas
authors: Hiren
authors: H
authors: Patel
authors: Dorota
authors: D
authors: Drozdz
authors: Karel
authors: K
authors: Vondrak
authors: Andreia
authors: A
authors: Watanabe
authors: Jorge
authors: J
authors: Villagra
authors: Onder
authors: O
authors: Yavascan
authors: Maria
authors: M
authors: Valenzuela
authors: Deborah
authors: D
authors: Gipson
authors: K H
authors: KH
authors: Ng
authors: Bradley A
authors: BA
authors: Warady
authors: Franz
authors: F
authors: Schaefer
mesh_terms: D000293:Adolescent; D001208:Asia / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007674:Kidney Diseases / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013020:South America / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult