Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 9, September, p. 1225–1231
Publication type: original article
Disturbances in intraventricular conduction in children with end-stage renal disease on peritoneal dialysis: A pilot study
1 Department of Pathophysiology, Wroclaw Medical University, Poland
2 Department of Pediatric Nephrology, Wroclaw Medical University, Poland
Background. The progression of chronic kidney disease is accompanied by multi-organ disorders, among which cardiovascular diseases have the status of a serious clinical problem. The body surface potential mapping (BSPM) technique is a non-invasive method which enables the detection of pathological changes in the bioelectrical activity of the heart.
Objectives. The aim of this study was to identify possible disturbances in the intraventricular conduction system in peritoneally dialyzed children.
Material and Methods. Cardiac examination consisted of 12-lead electrocardiography, echocardiography and BSPM. The evaluation of disturbances in the cardio-electrical field was performed by comparing the qualitative and quantitative features of the heart potentials on the isopotential map.
Results. Data was collected from 10 children treated with automatic peritoneal dialysis (APD) (mean age: 13.6 ±2.3 years) and 26 healthy children. The maps of dialyzed children showed a shift in positive isopotentials toward the left lower part of the thorax, while negative values were observed in its left upper part. A distribution of lines on the isopotential maps revealed disturbances in the stimulation spread within the heart ventricles, especially within the anterior fascicle of the left bundle branch of His.
Conclusion. Intraventricular conduction disturbances were observed in the left bundle branch of His in the peritoneally dialyzed children. The body surface potential mapping was a more sensitive method in identifying the early stage of conduction disturbances within the heart ventricles than 12-lead electrocardiography. Further research involving a larger population of dialyzed children is planned.
children, peritoneal dialysis, isopotential maps, body surface potential mapping
- Chavers BM, Li S, Collins AJ, Herzog CA. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 2002;62:648–653.
- Parekh RS. Expect the unexpected: Sudden cardiac death in dialysis patients. Clin J Am Soc Nephro. 2012;7:8–11.
- Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr. 2002;141:191–197.
- Almeida FA, Machado FC, Moura JA Jr, Guimarães AC. Global and cardiovascular mortality and risk factors in patients under hemodialysis treatment. Arq Bras Cardiol. 2010;94:187–192,201–206,190–195.
- Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32 (Suppl 3):S112–S119.
- US Renal Data System. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011. https://www.usrds.org/atlas11.aspx. Accessed December 15, 2015.
- Groothoff J, Liien M, Kar N, Wolff E, Davin J. Cardiovascular disease as a late complication of end-stage renal disease in children. Pediatr Nephrol. 2005;20:374–379.
- Laszki-Szcząchor K, Polak-Jonkisz D, Zwolińska D, Rusiecki L, Janocha A, Sobieszczańska M. Heart ventricular activation in VAT difference maps from children with chronic kidney disease. Pediatr Nephrol. 2012;27:251–259.
- The Fourth Report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Pediatrics. 2004;114:555–576.
- Wagner G. Marriott’s Practical Electrocardiography. 10th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2001.
- Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:567–581.
- Heart Potential Mapping System. Tokyo: Fukuda Denshi Co., Ltd. Bulletin; 1990.
- Khoury PR, Mitsnefes MS, Daniels SR, Kimball TR. Age specific reference intervals for indexed left ventricular mass index in children. J Am Soc Echocardiogr. 2009;22:709–714.
- Levey AS, Beto JA, Coronado BE, National Kidney Foundation Task Force on Cardiovascular Disease. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? Am J Kidney Dis. 1998;32:853–906.
- Van Biesen W, Verbeke F, Vanholder R. Cardiovascular disease in haemodialysis and peritoneal dialysis: Arguments pro peritoneal dialysis. Nephrol Dial Transplant. 2007;22:53–58.
- Pego C, Rodrigues A, Ronco C. Role of peritoneal dialysis as a chronic renal replacement therapy in cardiorenal patients. Contrib Nephrol. 2012;178:182–188.
- Robinson RF, Nahata MC, Sparks E, et al. Abnormal left ventricular mass and aortic distensibility in pediatric dialysis patients. Ped Nephrol. 2005;20:64–68.
- Mitsnefes MM, Kimball TR, Kartal J, et al. Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: Role of calcium-phosphorus metabolism. J Am Soc Nephrol. 2005;16:2796–2803.
- Wanic-Kossowska M, Lehmann P, Czekalski S. Left ventricular systolic and diastolic dysfunction in patients with chronic renal failure treated with hemodialysis. Pol Arch Med Wewn. 2003;109:365–373.
- Mitsnefes MM. Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol. 2012;23:578–585.
- Cozzolino M, Stucchi A, Rizzo MA, et al. Phosphate control in peritoneal dialysis. Contrib Nephrol. 2012;178:116–123.
- Mozos I. Laboratory markers of ventricular arrhythmia risk in renal failure. Hyperphosphatemia: Treatment options. Biomed Res Int. 2014. http://dx.doi.org/10.1155/2014/509204
- Wang AY. Calcium balance and negative impact of calcium load in peritoneal dialysis patients. Perit Dial Int. 2014;34:345–352.
- Russo D, Palmiero G, De Blasio AP, Balletta MM, Andreucci VE. Coronary artery calcification in patients with CRF not undergoing dialysis. Am J Kidney Dis. 2004;44:1024–1030.
- Fox CS, Larson MG, Keyes MJ, et al. Kidney function is inversely associated with coronary artery calcification in men and women free of cardiovascular disease: The framing ham heart study. Kidney Int. 2004;66:2017–2021.
- Iyer H, Abraham G, Reddy YN, et al. Risk factors of chronic kidney disease influencing cardiac calcification. Saudi J Kidney Dis Transpl. 2013;24:1189–1194.
- Bosch A, Ulmer HE, Keller HE, Bonzel KE, Schärer K. Electrocardiographic monitoring in children with chronic renal failure. Pediatr Nephrol. 1990;42:140–144.
- Margetts PJ, McMullin JP, Rabbat CG, Churchill DN. Peritoneal membrane transport and hypoalbuminemia: Cause or effect? Perit Dial Int. 2000;20:14–18.
- Segall L, Covic A. Cardiovascular disease in haemodialysis and peritoneal dialysis: Arguments for haemodialysis. Nephrol Dial Transplant. 2007;22:59–63.
- Devereux RB, Alonso DR, Lutas EM, et al. Echoradiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol. 1986;57:450–458.
- Scharer K, Schmidt KG, Soergel M. Cardiac function and structure in patients with chronic renal failure. Pediatr Nephrol. 1999;13:951–965.