Cardiac and Parathyroid Functions in Children on Regular Hemodialysis Treatment

ABSTRACT
Background: Cardiovascular diseases are the major cause of mortality in uremic patients treated dy hemodialysis. Left ventricular dysfunction is considered a major risk factor. It has been shown that elevated plasma phosphate, calcium phosphate product and parathyroid hormone (PTH)are associated with an increase incidence of cardiovascular calcification and cardiovascular disease. Objectives: This study investigated the parathyroid gland function in relation to the degree of uremia and anemia. It also aimed at detecting cardiac abnormalities in children with end-stage renal disease (ESRD) after initiation of dialysis especially left ventricular function. Methods: The present study included 25 children with ESRD who were on regular hemodialysis treatment. Their age ranged from four to 18 years. All children were subjected to thorough history taking and clinical examination, laboratory assessment in the form of: complete blood count, serum iron, total iron binding capacity, serum ferritin, pre-and post-dialysis kidney function tests, Parathyroid hormone level, pre-and post-dialysis echocardiography for assessment of systolic and diastolic functions of the left ventricle. Results: The level of PTH was elevated in 44%. There was significant intra dialytic change in E/A ratio (The ratio of transmitral carly diastolic flow to late atrial systole) indicating left ventricular diastolic impairment. Left ventricular myocardial performance index (LVMPI) was prolonged in 56% and there was significant correlation between PTH and LVMPI (p=0.03) confirming the fact that the secondary hyperparathyroidism and the disturbances of calcium-phosphorus metabolism contribute to left ventricular hypertrophy and impaired left ventricular function. Conclusions: Children with uremia exhibit cardiac abnormalities that may contribute to increase morbidity and mortality. These abnormalities are related to secondary hyperparathyroidism that frequently occurs in chronic renal failure.