Diastolic dysfunction in paediatric patients on peritoneal dialysis and after renal transplantation

BACKGROUND: Cardiovascular disease is the leading cause of death in children with end-stage renal disease. We investigated the presence of cardiac systolic and diastolic dysfunction in patients on peritoneal dialysis or after renal transplantation. Methods and results. Fourteen patients on peritoneal dialysis for a mean of 1.4 years (range 0.1-5.3) and 39 patients with a functioning kidney transplant for a median time of 3.3 years (range 1.2-14.5) were studied. These patients were compared to 153 age-matched healthy controls. As assessed by echocardiography, both dialysis and transplant patients showed left ventricular dysfunction. Systolic tissue Doppler values were lower as compared to controls. Mitral E/A ratios were significantly lower as well, indicating diastolic dysfunction (transplant 1.82 +/- 0.58 versus 2.15 +/- 0.63, P < 0.01; dialysis patients 1.57 +/- 0.73 versus 2.31 +/- 0.52, P < 0.01). Also, tissue Doppler values were different, showing an increased E/E' ratio in the patients, indicating diastolic dysfunction (transplant 9.49 +/- 1.71 versus 7.50 +/- 1.60, P < 0.01; dialysis patients 11.90 +/- 2.11 versus 8.10 +/- 1.24, P < 0.01). The left ventricular mass index was increased in the transplant patients (controls 25 +/- 7 g/m(2.7); transplant 59 +/- 64 g/m(2.7); P < 0.01), as well as in the dialysis patients (controls 28 +/- 7 g/m(2.7); dialysis 43 +/- 11 g/m(2.7); P < 0.01) and was associated with systolic hypertension (R = 0.46, P < 0.05). High parathyroid hormone (PTH) levels, more prevalent in dialysis patients, were associated with abnormal E/A and E/E' ratios. CONCLUSIONS: Abnormalities in diastolic function are present in both peritoneal dialysis and renal transplanted patients. In the dialysis group, abnormalities in calcium-phosphate metabolism are associated with diastolic dysfunction. Cardiac hypertrophy was noted in both patient groups and was associated with systolic hypertension.