Left ventricular mass and cardiac function in pediatric dialysis patients

• Cardiovascular disease is a major determinant of morbidity in children with chronic kidney disease.
• The pathologic process is distinct from atherosclerosis with different risk factors.
• Left ventricular hypertrophy is the most common manifestation.
• Most patients remain asymptomatic and a few develop congestive heart failure.
• Most patients improve after kidney transplantation but may have residual damage.

Cardiovascular disease is a major determinant of morbidity and may impact on life expectancy of children with chronic kidney disease. Myocardial disease in children requiring renal replacement therapy in the form of dialysis is distinct from atherosclerosis commonly found in the adult population. Left ventricular hypertrophy associated with diastolic dysfunction and to a lesser extent by systolic dysfunction is the most common manifestation. Most patients remain asymptomatic whereas some may develop congestive heart failure. Abnormalities in cardiac structure and function are usually detected by echocardiogram, although in recent years the use of cardiac magnetic resonance imaging emerges as a potential alternative. The pathophysiological mechanisms underlying cardiac disease are complex and an attempt has been made to dissect the main risk factors. Given the high incidence of cardiac disease among children with end-stage kidney disease mandates timely diagnosis of this condition and underscores the need to identify risk factors which are amenable to preventive or interventional measures. Kidney transplantation may significantly improve the cardiac status.