CJASN
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published ahead of print on April 1, 2009
Clin J Am Soc Nephrol 4: 790-797, 2009
© 2009 American Society of Nephrology
doi: 10.2215/CJN.05921108
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
CJN.05921108v1
4/4/790    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hothi, D. K.
Right arrow Articles by McIntyre, C. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hothi, D. K.
Right arrow Articles by McIntyre, C. W.

Dialysis

Pediatric Myocardial Stunning Underscores the Cardiac Toxicity of Conventional Hemodialysis Treatments

Daljit K. Hothi*, Lesley Rees*, Jan Marek{dagger}, James Burton{ddagger}, and Christopher W. McIntyre{ddagger},§

Departments of * Nephro-urology and {dagger} Pediatric Cardiology, Great Ormond Street Hospital for Children, London, {ddagger} Department of Renal Medicine, Derby City General Hospital, Derby, and § School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, United Kingdom

Correspondence: Dr. Christopher W. McIntyre, Department of Renal Medicine, Derby City General Hospital, Uttoxeter Road, Derby DE22 3NE, UK. Phone: +44-1332-340131; Fax: +44-1332-625975; E-mail: chris.mcintyre{at}nottingham.ac.uk

Background and objective: In adults, hemodialysis (HD)-induced ischemia causes reversible myocardial dysfunction (myocardial stunning) that is progressive with raised attendant mortality. Children share an increased risk for death from a spectrum of uremia-related cardiovascular abnormalities but in the absence of significant classical atheromatous coronary artery disease; therefore, we elected to assess children who were on HD for the occurrence of myocardial stunning to investigate the relative importance of characteristic uremic cardiovascular abnormalities in the development of ischemic cardiac injury.

Design, setting, participants, & measurements: We included all single-center long-term HD patients (n = 12; range 2 to 17 yr), excluding those with structural cardiac disease. Patients underwent conventional thrice-weekly HD for 4 h using high-flux membranes. We measured regional left ventricle wall motion using serial echocardiography (before HD, during HD, and 15 min after HD). Significant stunning was defined as a 20% reduction in regional wall motion (RRWM) in two or more segments and hyperkinesis as an either >20 or >50% increase in shortening fraction (SF).

Results: Eleven of 12 patients developed myocardial stunning with varying degrees of compensatory hyperkinesis in unaffected segments, maintaining left ventricular ejection fraction throughout HD. The mean segmental %SF[Overall] and %SF[RRWM] fell during HD (2.19 to 1.77 and 2.72 to 1.37, respectively). Intradialytic BP reduction was significantly associated with mean segmental %SF[RRWM].

Conclusions: Children who receive conventional HD experience myocardial stunning. These data, in combination with previous adult studies of intradialytic myocardial blood flow, suggest a characteristic cardiovascular phenotype in HD patients that predisposes to significant demand ischemia.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2009 by the American Society of Nephrology.