Skip to main content
SpringerLink
Log in

Evaluation of the coronary circulation and calcification in children on regular hemodialysis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to evaluate the coronary circulation and calcification in children with end-stage renal disease (ESRD) on hemodialysis.

Methods

A total of 50 children with ESRD and 50 healthy controls were enrolled in the study. Cardiac functions and coronary blood flow were evaluated with conventional and tissue Doppler echocardiography. Coronary artery calcification (CAC) was evaluated using high-resolution multidetector computed tomography (CT).

Results

The hyperemic coronary flow volume (CFV) and coronary flow reserve were significantly lower in the patient group than in the controls, while there was no significant difference in the baseline CFV between the two groups. Hypertension was present in 60% and CAC was observed in 20% of the children in the patient group. CAC was present in 30% of the children in the hypertensive subgroup. The left ventricle myocardial performance index (LV MPI), CAC score, duration of hypertension and level of diastolic blood pressure were independent predictors of the coronary blood flow, and LV MPI, serum parathyroid hormone, duration of dialysis and E′/A′ mitral valve were independent predictors of coronary calcification.

Conclusion

High diastolic blood pressure, long duration of hypertension, high LV MPI and increased CAC scores are independent risk factors for impaired coronary blood flow in children with ESRD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mitsnefes MM (2012) Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 23(4):578–585

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Shaw C, Sharpe CC (2015) Early invasive treatment for acute coronary syndrome in patients with chronic kidney disease: do we know what we’re doing? Future Cardiol 11(1):5–8

    Article  CAS  PubMed  Google Scholar 

  3. Chavers BM, Li S, Collins AJ, Herzog CA (2002) Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 62(2):648–653

    Article  PubMed  Google Scholar 

  4. Milliner DS, Zinsmeister AR, Lieberman E, Landing B (1990) Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 8(5):931–936

    Article  Google Scholar 

  5. Civilibal M, Caliskan S, Adaletli I, Oflaz H, Sever L, Candan C, Canpolat N, Kasapcopur O, Kuruoglu S, Arisoy N (2006) Coronary artery calcifications in children with end-stage renal disease. Pediatr Nephrol. 21(10):1426–1433

    Article  PubMed  Google Scholar 

  6. Langman CB, Brooks ER (2006) Renal osteodystrophy in children: a systemic disease associated with cardiovascular manifestations. Growth Horm IGF Res 16[Suppl A]:S79–S83

    Article  PubMed  Google Scholar 

  7. Hakeem A, Bhatti S, Chang SM (2014) Screening and risk stratification of coronary artery disease in end-stage renal disease. JACC Cardiovasc Imaging 7(7):715–728

    Article  PubMed  Google Scholar 

  8. Gurm HS, Gore JM, Anderson FA Jr, Wyman A, Fox KA, Steg PG, Eagle KA, Global Registry of Acute Coronary Events (GRACE) Investigators (2012) Comparison of acute coronary syndrome in patients receiving versus not receiving chronic dialysis (from the Global Registry of Acute Coronary Events [GRACE] Registry). Am J Cardiol 109(1):19–25

    Article  PubMed  Google Scholar 

  9. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114[2 Suppl 4th Report]:555–576

    Article  Google Scholar 

  10. Abid L, Rekik H, Jarraya F, Kharrat I, Hachicha J, Kammoun S (2014) Acute hemodialysis effects on Doppler echocardiographic indices. Saudi J Kidney Dis Transpl 25(4):756–761

    Article  PubMed  Google Scholar 

  11. Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, Keller AM, Malenka DJ, Masoudi FA, McCulloch M, Pellikka PA, Peters PJ, Stainback RF, Strachan GM, Zoghbi WA, American Society of Echocardiography (2011) American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 24(1):1–10

    Article  PubMed  Google Scholar 

  12. Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22(6):709–714

    Article  PubMed  Google Scholar 

  13. Al-Biltagi M, Tolba OA, ElHafez MA, Abo-Elezz AA, El Kady EK, Hazza SM (2016) Oxidative stress and cardiac dysfunction in children with chronic renal failure on regular hemodialysis. Pediatr Nephrol 31(8):1329–3139

    Article  PubMed  Google Scholar 

  14. Harada K, Yasuoka K, Tamura M, Toyono M (2002) Coronary Flow Reserve Assessment by Doppler Echocardiography in Children with and Without Congenital Heart Defect: Comparison with Invasive Technique. J Am Soc Echocardiogr 15(10 Pt 2):1121–1126

    Article  PubMed  Google Scholar 

  15. Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, Seward SB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9:838–847

    Article  CAS  PubMed  Google Scholar 

  16. Conti CR (2016) Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging 9(3):330–331

    Article  PubMed  Google Scholar 

  17. Anderson TJ (2006) Arterial stiffness or endothelial dysfunction as a surrogate marker of vascular risk. Can J Cardiol 22(Suppl B):72B–80B

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kozàkovà M, Palombo C, Pratali L, Pittella G, Galetta F, L’Abbate A (1997) Mechanisms of coronary flow reserve impairment in human hypertension. An integrated approach by transthoracic and transesophageal echocardiography. Hypertension 29(2):551–559

    Article  PubMed  Google Scholar 

  19. Mitsnefes M, Ho PL, McEnery PT (2003) Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol 14(10):2618–2622

    Article  PubMed  Google Scholar 

  20. London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, Metivier F (1996) Cardiac and arterial interactions in end-stage renal disease. Kidney Int 50(2):600–608

    Article  CAS  PubMed  Google Scholar 

  21. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, Warady BA, Chronic Kidney Disease in Children Study Group (2008) Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension 52(4):631–637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Samuels J, Ng D, Flynn JT, Mitsnefes M, Poffenbarger T, Warady BA, Furth S, Chronic Kidney Disease in Children Study Group (2012) Ambulatory blood pressure patterns in children with chronic kidney disease. Hypertension 60(1):43–50

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Caliskan Y, Oflaz H, Demirturk M, Yazici H, Turkmen A, Cimen A, Elitok A, Yildiz A (2008) Coronary flow reserve dysfunction in hemodialysis and kidney transplant patients. Clin Transplant 22(6):785–793

    Article  PubMed  Google Scholar 

  24. Pizzuto F, Voci P, Mariano E, Puddu PE, Chiavari PA, Romeo F (2003) Noninvasive coronary flow reserve assessed by transthoracic coronary Doppler ultrasound in patients with left anterior descending coronary artery stents. Am J Cardiol 91(5):522–526

    Article  PubMed  Google Scholar 

  25. Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, Lamberti M, Pezone N, Pota A, Russo L, Sacco M, Scognamiglio B (2011) Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 80:112–118

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shemesh J, Motro M, Morag-Koren N, Tenenbaum A, Apter S, Weiss A, Grossman E (2011) Coronary artery calcification predicts long-term mortality in hypertensive adults. Am J Hypertens 24(6):681–686

    Article  PubMed  Google Scholar 

  27. Urena-Torres PA, Floege J, Hawley CM, Pedagogos E, Goodman WG, Petavy F, Reiner M, Raggi P (2013) Protocol adherence and the progression of cardiovascular calcification in the ADVANCE study. Nephrol Dial Transplant 28(1):146–152

    Article  CAS  PubMed  Google Scholar 

  28. Neves PD, Bridi RA, Elias RM, Moyses RM (2015) Coronary artery calcification seen through chest radiography. J Clin Med Res 7(9):724–725

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Lumpaopong A, Mathew AV, John E, Jelnin V, Benedetti E, Testa G, Oberholzer J, Sankary H, Ruiz C (2007) Early coronary calcification in children and young adults with endstage renal disease. Transplant Proc 39(1):37–39

    Article  CAS  PubMed  Google Scholar 

  30. Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE (2009) The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol 53(23):2129–4210

    Article  PubMed  Google Scholar 

  31. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342(20):1478–1483

    Article  CAS  PubMed  Google Scholar 

  32. Matsuoka M, Iseki K, Tamashiro M, Fujimoto N, Higa N, Touma T, Takishita S (2004) Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol 8(1):54–58

    Article  PubMed  Google Scholar 

  33. Cui L, Xu J, Bai Y, Zhang J (2015) Risk factors for coronary artery calcification in patients with end-stage renal disease. Zhonghua Yi Xue Za Zhi 95(38):3133–3137

    CAS  PubMed  Google Scholar 

  34. Iyer H, Abraham G, Reddy YN, Pandurangi UM, Kalaichelvan U, Gomathi SB, Mathew M, Santhosham R (2013) Risk factors of chronic kidney disease influencing cardiac calcification. Saudi J Kidney Dis Transpl 24(6):1189–1194

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbia, Egypt

    Mohammed Al-Biltagi, Maher Ahmed Abd ElHafez, Doaa Mohamed El Amrousy & Mohamed El-Gamasy

  2. Faculty of Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain

    Mohammed Al-Biltagi

  3. Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbia, Egypt

    Hesham El-Serogy

Authors
  1. Mohammed Al-Biltagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maher Ahmed Abd ElHafez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Doaa Mohamed El Amrousy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed El-Gamasy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hesham El-Serogy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammed Al-Biltagi.

Ethics declarations

Ethical approval and consent to participate

The study was approved by the Ethics Committee of the Faculty of Medicine of Tanta University and conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments as regard to Research involving Human Participants. Written informed consent was obtained from each child’s guardian, with assurance of patient privacy.

Conflict of interest

All authors declare that they have no financial or ethical conflicts of interest regarding this work. The research was funded by Fcaulty of Medicine, Tanta University, Egypt

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al-Biltagi, M., ElHafez, M.A.A., El Amrousy, D.M. et al. Evaluation of the coronary circulation and calcification in children on regular hemodialysis. Pediatr Nephrol 32, 1941–1951 (2017). https://doi.org/10.1007/s00467-017-3678-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-017-3678-4

Keywords

Search

Navigation