Renal Effect on Children's Heart (REACH), a prospective observational study on cardiac dysfunction among paediatric CKD patients.

BACKGROUND

While the presence of cardiorenal syndrome in the adult population is well-documented, there is limited understanding of cardiorenal syndrome in paediatric patients with chronic kidney disease (CKD). Our objective was to assess the prevalence of left ventricular hypertrophy, left ventricular diastolic dysfunction, and left ventricular systolic dysfunction in children with CKD. Additionally, we conducted follow-up evaluations to track the incidence of cardiac events.

METHODS

We recruited children aged 2-18 years old with estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73 m2 or on dialysis, and performed transthoracic echocardiography to evaluate the left ventricular mass and left ventricular systolic and diastolic function. They underwent anthropometric assessment and serum measurement at baseline, and were followed up for 6 months.

RESULTS

Among 45 children recruited, 33 (73.3%) were on dialysis, 28 (84.8%) of whom were on peritoneal dialysis. The prevalences of left ventricular hypertrophy, left ventricular diastolic dysfunction, left ventricular systolic dysfunction were 42.2%, 15.6%, and 8.9%, respectively. Concomitant left ventricular diastolic dysfunction and left ventricular systolic dysfunction were present in 6.7% of children. The presence of left ventricular diastolic dysfunction was significantly associated with left ventricular hypertrophy (P < .001), left ventricular systolic dysfunction (P < .001), and higher left ventricular mass index Z score (P < .001). Left ventricular hypertrophy was associated with the presence of hypertension (P = .035) and inadequate blood pressure (BP) control (P = .033), while left ventricular diastolic dysfunction was associated with lower body mass index (BMI) z score (P = .01) and lower serum albumin (P = .045). Over a 6-month follow up period, 52.6% of children with left ventricular hypertrophy and 71.4% with left ventricular diastolic dysfunction developed a cardiovascular event or died.

CONCLUSION

Structural and functional cardiac changes are highly prevalent among children with CKD, putting them at significant risk of cardiovascular events and death.