Cardiac complications in children with chronic renal: Prevalence of risk factors

Objectives Cardiovascular complications are the leading cause of death and morbidity in chronic hemodialysis patients. The purpose of this study was to identify the factors associated with major cardiovascular events in hemodialysis children. Methods Bi-centric study was carried out during in 2016 into two hemodialysis departments. We included hemodialysis children for more than one year. Results Fifty-two patients were included, sex ratio M/F: 1.3, average age: 10.7 years-old (3–16). The dialysis duration was 72.5 ± 1.6 months. Cardiac risk factors were evaluated: the hemoglobin blood concentration was  Clinical and biological secondary hyperparathyroidism was diagnosed in 21.06% of patients. An acute pulmonary edema (APO) occurred in 45% of patients and pericarditis in 10%. Overall heart failure (1.20%), and arrhythmias (11.90%) were also retrieved. Echocardiography allowed to identify 21% of patients with pulmonary arterial hypertension (PAH); 86% of patients evidenced left ventricular hypertrophy and 50% a dilation of the left ventricle. PAH and LV dilatation were the most frequent morphological abnormalities. Posterior pericardial detachment was found in a proportion of 11.04%. Mitral and tricuspid valves abnormalities were noted in 31 patients. Three patients died during the study (hemorrhagic stroke in 2 patients, and overall heart failure in 1 patient), after an average duration of hemodialysis treatment of 2.5 years. Multivariate analysis allowed to show that severe arterial hypertension (RR = 12.15 [3.2–34.1]) and left ventricular systolic dysfunction (RR = 2.5 [1.02–08.3]) were major risk factors for mortality. Conclusion Cardiovascular complications are almost constant in hemodialysis children with chronic renal failure strongly related with left ventricular hypertrophy and arterial hypertension. The high risk of mortality related to these cardiac complications makes it essential to have good control of arterial blood pressure and especially a good observance of treatment and regimen in hemodialysis children.