Cardiovascular Function in Pediatric Chronic Kidney Disease

Pediatric chronic kidney disease (CKD) exerts a profound impact on cardiovascular health, with alterations in cardiac structure and function emerging early in the disease course. As glomerular filtration rate declines, pressure and volume overload, uraemic toxins and anaemia contribute to left ventricular remodelling, hypertrophy and subtle myocardial dysfunction. Both systolic and diastolic parameters are affected: conventional measures such as ejection fraction often remain normal while more sensitive indices of early systolic shortening and diastolic filling reveal impairment. Elevated blood pressure and arterial stiffness further exacerbate afterload, promoting concentric remodelling and fibrosis. Over time, subclinical dysfunction may progress to overt heart failure, accelerating morbidity and mortality. Timely identification of these changes using advanced imaging and circulating biomarkers offers opportunities for intervention, including optimisation of blood pressure control, correction of anaemia and modulation of uraemic milieu, with the aim of preserving long-term cardiovascular health in this vulnerable population.

Research from Nature Portfolio

Recent studies employing tissue Doppler imaging have unveiled concurrent impairments of systolic and diastolic left ventricular function in children with moderate to advanced CKD. Detailed analysis of longitudinal and annular velocities demonstrated reduced early diastolic inflow and systolic annular motion compared with healthy peers, indicating diminished myocardial relaxation and contractility. The severity of dysfunction correlated with declining renal function and elevated systolic blood pressure, and was partially mitigated in those receiving renin–angiotensin system blockade. Despite preserved global ejection fraction, these subtle alterations point to early cardiac involvement and highlight tissue Doppler metrics as sensitive tools for monitoring myocardial performance in paediatric CKD cohorts.

Cardiovascular Function in Pediatric Chronic Kidney Disease publication trend

The graph below shows the total number of articles in cardiovascular function in pediatric chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated measure of kidney filtration capacity, used to stage CKD severity.

First-phase ejection fraction (EF1): The proportion of left ventricular volume expelled by peak aortic flow, reflecting early systolic function.

Tissue Doppler imaging: An echocardiographic technique measuring myocardial velocity at specific annular points to assess systolic and diastolic performance.

Speckle-tracking echocardiography: Advanced ultrasound method that tracks natural acoustic markers within myocardium to quantify strain and deformation.

Left ventricular mass index (LVMI): The left ventricular mass normalised to body surface area, used to detect hypertrophy.

References

1. Decline in Left Ventricular Early Systolic Function with Worsening Kidney Function in Children with Chronic Kidney Disease: Insights from the 4C and HOT-KID Studies. Journal of the American Society of Echocardiography (2023).
2. Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study. Scientific Reports (2019).
3. Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease. Pediatric Nephrology (2016).
4. Echocardiogram screening in pediatric dialysis and transplantation. Pediatric Nephrology (2022).
5. Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography. Pediatric Nephrology (2022).
6. Cardiac biomarkers in pediatric CKD—a prospective follow-up study. Pediatric Nephrology (2022).