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8064232 
Journal Article 
Early cardiac dysfunction in pediatric patients on maintenance dialysis and post kidney transplant 
Malatesta-Muncher, R; Wansapura, J; Taylor, M; Lindquist, D; Hor, K; Mitsnefes, M 
2012 
1 
Pediatric Nephrology
ISSN: 0931-041X
EISSN: 1432-198X 
27 
7 
1157-1164 
English 
22358192 
WOS:000304626700016 
BACKGROUND: Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31P MRS) to assess markers of cardiac dysfunction in young CKD patients.

METHODS: Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison.

RESULTS: All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r= -0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02).

CONCLUSION: Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy. 
Cardiac MRI; Cardiovascular; Children; Chronic kidney disease; Dialysis; Transplant