Anemia and hypoalbuminemia as risk factors for left ventricular diastolic dysfunction in children with chronic kidney disease on peritoneal dialysis

Introduction: Left ventricular diastolic dysfunction (LVDD) is an independent predictor of mortality in Chronic Kidney Disease (CKD). The increase in the E/e' ratio is an indicator of LVDD. The association between cardiovascular risk factors (CVREs) and E/e' in children with automated peritoneal dialysis (APD) has not been widely studied. Objective: To measure the association between CVRFs and E/e' in children with CKD on APD. Methods: Cross-sectional, prolective, observational, analytical study of children aged 6-16 years on APD. We recorded age, gender, time since onset, time on dialysis, and measured weight, height, blood pressure, hemoglobin, albumin, calcium, phosphorus, parathyroid hormone, and C-reactive protein. E/e' ratio was measured and considered to have increased when it was higher than 15. Results: Twenty-nine children were studied, (19 females). Age was 14.0 +/- 2.5 years, and 16.9 + 11.2 months with substitutive therapy. One patient had reduced left ventricular ejection fraction, and 21 (72.4%) had increased E/e'. E/e' correlated significantly with hemoglobin (r = P =.003). Hemoglobin and albumin were significantly lower (9.72 +/- 1.9 vs. 12.2 +/- 1.8; P =.004 and 3.6 0.5 vs. 4.0 0.3; P=.035) and the proportion of patients with anemia and hypoalbuminemia was significantly higher (85.7% vs. 37.5%; P=.019 and 61.9% vs. 12.5%; P =.035) in patients with increased E/e'. Hemoglobin was the only independent predictor of E/e' (beta =-0.66; P =.020) and patients with anemia were 10 times more likely to have increased E/e' (95% CI 1.5-65.6, P=.016). Conclusions: 75% of the children had increased E/e. Anemia and hypoalbuminemia were significantly related with an increased E/e'. (C) 2018 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.