Interdialytic weight gain, carotid intima media thickness, and cardiovascular profile in children undergoing chronic hemodialysis: a multicenter study

BACKGROUND: Increased interdialytic weight gain (IDWG) and carotid intima media thickness (cIMT) have been known to affect cardiovascular profiles in patients with kidney failure. However, the impact on children undergoing dialysis remains unclear. METHODS: Forty-two children undergoing dialysis from two centers were enrolled. Clinical and hemodialysis parameters were collected in every dialysis session twice a week. Cardiovascular parameters were assessed using echocardiography, including assessment of left ventricular mass index (LVMI), relative wall thickness (RWT), ejection fraction (EF), fractional shortening (FS), E/A ratio, tricuspid annular plane systolic excursion (TAPSE), and cIMT. Left ventricular hypertrophy was defined by LVMI greater than 45 g/m2. RESULTS: Our echocardiography assessment revealed that LVH was present in 36 out of 42 patients. However, there were no significant differences in both IDWG groups. IDWG was not associated with LVMI or cIMT standard deviation score (SDS), indicating that fluid gain alone did not drive cardiac or vascular remodeling. In contrast, cIMT SDS correlated positively with serum calcium, blood flow rate Qb/kg, diastolic blood pressure SDS, and negatively with hemodialysis duration. Among echocardiographic parameters, only the E/A ratio was related to cIMT SDS, linking increased carotid thickness specifically to diastolic dysfunction. In multivariate models, systolic blood pressure SDS was identified as an independent predictor of LVH, whereas serum calcium and blood flow rate (Qb/kg) were found to be significant independent predictors of cIMT SDS. These findings suggest a potential role of mineral imbalance and hemodynamic factors in vascular remodeling in pediatric hemodialysis. CONCLUSIONS: High IDWG was not independently linked to LV hypertrophy. Elevated cIMT SDS was associated with diastolic dysfunction. Furthermore, serum calcium and dialysis blood flow were identified as independent predictors of increased cIMT SDS. These findings indicate that cardiovascular risk in pediatric hemodialysis involves a complex interplay of mineral metabolism and hemodynamic factors, suggesting that fluid gain is not the sole determinant of vascular health.