Key result
Advanced pediatric CKD is linked to ~14-point lower left atrial reservoir strain vs early-stage disease.
Why the study?
Diastolic dysfunction is an early cardiac manifestation of pediatric CKD that is often subclinical and may go undetected by conventional echocardiography. Left atrial speckle tracking echocardiography offers a potentially sensitive method to evaluate these early diastolic functional changes across CKD stages.
Does left atrial speckle tracking echocardiography detect impaired diastolic function in children with advanced-stage chronic kidney disease compared to early-stage chronic kidney disease?
Cross-Sectional (n=44)
No
Does left atrial speckle tracking echocardiography detect impaired diastolic function in children with advanced-stage chronic kidney disease compared to early-stage chronic kidney disease?
Left atrial speckle tracking echocardiography detects significant subclinical diastolic dysfunction (reduced LA reservoir, conduit, and contractile strain, and elevated stiffness and filling indices) in children with advanced CKD compared to early-stage CKD, despite preserved LVEF.
May indicate subclinical diastolic impairment in advanced pediatric CKD; leaves open prospective validation before clinical adoption.
Background: Chronic Kidney Disease (CKD) in children was associated with an increased risk of long-term cardiovascular morbidity and mortality. Diastolic dysfunction, represented by an early cardiac manifestation of CKD, was often subclinical and might not be detected by conventional echocardiography. Speckle Tracking Echocardiography (STE), which assesses left atrial function, provided a potentially sensitive evaluation of early diastolic functional changes. This study aimed to compare stages of CKD in children with diastolic function parameters assessed by STE. Methods: An analytic cross-sectional study conducted at RSUP M. Djamil Padang from September to December 2025, involving 44 children with CKD who were divided equally into two groups: Group I, early-stage CKD (stages 1–3) children, and Group II, advanced-stage CKD (stages 4–5) children. STE was performed to assess Left Atrial Reservoir Strain (LASr), Conduit Strain (LAScd), and Contractility Strain (LASct). Combination with echocardiography, conventional and STE by evaluating Left Atrial Stiffness Index (LASI) from E/e’ / LASr, and Left Atrial Filling Index (LAFI) from E transmitral velocity / LASr was performed in both groups. Statistical analyses included the Shapiro–Wilk normality test, followed by an independent t-test or Mann–Whitney test. Results: In this study, no significant differences were found in age, sex, comorbidities, therapy, Left Ventricular Ejection Fraction (LVEF), and Left Atrium dimension between the two groups. The left atrial speckle tracking parameters in Groups I and II were as follows: LASr 44.89±2.22% vs 30.54±6.25% (p=0.000); LAScd ?33.50±3.66% vs. ?21.65±7.57% (p=0.000); LASct ?11.35% (?5.4 to ?17.8%) vs ?7.70% (?2.1 to ?21.0%) (p=0.018); LASI 0.15 (0.12–0.26) vs 0.32 (0.18–0.82) (p=0.000); and LAFI 1.99 (1.38–3.04) vs. 2.93 (2.19–6.65) (p=0.000). Conclusions: Children with advanced-stage CKD demonstrated significantly reduced LASr, LAScd, and LASct and increased LASI and LAFI compared with those with early-stage CKD, indicating impaired diastolic function detected by left atrial STE.
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Firmansyah et al. (2026) conducted a cross-sectional in Pediatric Chronic Kidney Disease (CKD) (n=44). Advanced-stage CKD (stages 4–5) vs. Early-stage CKD (stages 1–3) was evaluated on Left Atrial Reservoir Strain (LASr) (%) (MD 14.35, 95% CI 11.49 to 17.20, p=0.000). Advanced-stage CKD in children was associated with significantly lower left atrial reservoir strain compared to early-stage CKD (30.54% vs 44.89%, p=0.000), indicating impaired diastolic function.
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