title: Effect of the timing of dialysis initiation on left ventricular hypertrophy and ınflammation in pediatric patients.
abstract: The optimal time for dialysis initiation in adults and children with chronic kidney disease remains unclear. The aim of this study was to evaluate the impact of dialysis timing on different outcome parameters, in particular left ventricular (LV) morphology and inflammation, in pediatric patients receiving peritoneal dialysis and hemodialysis.
  
  
  
  The medical records of pediatric dialysis patients who were followed-up in nine pediatric nephrology centers in Turkey between 2008 and 2013 were retrospectively reviewed. In addition to demographic data, we retrieved anthropometric measurements, data on dialysis treatment modalities, routine biochemical parameters, complete blood count, serum ferritin, parathormone, C-reactive protein (CRP), and albumin levels, as well as echocardiographic data and hospitalization records. The patients were divided into two groups based on their estimated glomerular filtration ﻿rate (eGFR) levels at dialysis initiation, namely, an early-start group, characterized by an eGFR of >10 ml/min/1.73 m2, and a late-start group, with an eGFR of < 7 ml/min/1.73 m2. The collected data were compared between these groups.
  
  
  
  A total of 245 pediatric dialysis patients (mean age ± standard deviation 12.3 ± 5.1 years, range 0.5-21 years) were enrolled in this study. Echocardiographic data were available for 137 patients, and the mean LV mass index (LVMI) was 58 ± 31 (range 21-215) g/m2.7. The LVMI was 75 ± 30 g/m2.7(n = 81) and 34 ± 6 g/m2.7(n = 56) in patients with or without LV hypertrophy (LVH) (p < 0.001). Early-start (eGFR >10 ml/min/1.73 m2) versus late-start dialysis (eGFR < 7 ml/min/1.73 m2) groups did not significantly differ in LVMI and LVH status (p > 0.05) nor in number of hospitalizations. Serum albumin levels were significantly higher in the early-dialysis group compared with the late-dialysis group (3.3 ± 0.7 vs. 3.1 ± 0.7 g/dl, respectively; p < 0.05). The early-start group had relatively higher time-averaged albumin levels (3.2 ± 0.5 vs. 3.1 ± 0.5 g/dl; p = > 0.05) and relatively lower CRP levels (3.64 ± 2.00 vs. 4.37 ± 3.28 mg/L, p > 0.05) than the late-start group, but these differences did not reach statistical significance.
  
  
  
  Although early dialysis initiation did not have a significant effect on important clinical outcome parameters, including LVH, inflammatory state, and hospitalization, in our pediatric dialysis patients, this area of study deserves further attention.
authors.affiliation: Department of Pediatric Nehprology, School of Medicine, Gazi University, Ankara, Turkey. sevcan@gazi.edu.tr.
authors.forename: Sevcan A
authors.initials: SA
authors.lastname: Bakkaloğlu
authors.affiliation: Department of Pediatric Nehprology, School of Medicine, Gazi University, Ankara, Turkey.
authors.forename: Yaşar
authors.initials: Y
authors.lastname: Kandur
authors.affiliation: Department of Pediatric Nephrology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
authors.forename: Erkin
authors.initials: E
authors.lastname: Serdaroğlu
authors.affiliation: Department of Pediatric Nehprology, School of Medicine, Başkent University, Adana, Turkey.
authors.forename: Aytül
authors.initials: A
authors.lastname: Noyan
authors.affiliation: Department of Pediatric Nephrology, School of Medicine, Çukurova University, Adana, Turkey.
authors.forename: Aysun Karabay
authors.initials: AK
authors.lastname: Bayazıt
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
authors.affiliation: Department of Pediatric Nephrology, Dr.Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey.
authors.forename: Sare Gülfem
authors.initials: SG
authors.lastname: Özlü
authors.affiliation: Department of Pediatric Nephrology, Şişli Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Gül
authors.initials: G
authors.lastname: Özçelik
authors.affiliation: Department of Pediatric Nehprology, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Dursun
authors.affiliation: Department of Pediatric Nephrology, Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: Caner
authors.initials: C
authors.lastname: Alparslan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
keywords: Children; Early dialysis; Glomerular filtration rate; Late dialysis; Left ventricular hypertrophy