ABSTRACT
End stage renal disease [ESRD] is a situation with a cardiovascular risk profile of unique severity; this study was designed to detect the cardiac abnormalities among children with ESRD and to evaluate the relation between inflammation as detected by CRP and these disorders. The present study was carried out on 60 children with ESRD on regular hemodialysis. [30 hypertensive, and 30 normo-tensive] and 30 apparently healthy age and sex matched children studied as a control group. All studied children were subjected to full history taking, thorough clinical examination and anthropometric measurements. Echocardiography, ECG and chest X-ray were also performed. Laboratory investigations included: Hb, S.alb, S.Ca, S.P, alkaline phophatase, lipid profile, kidney functions as well as CRP both by latex agglutination and ELISA for high sensitive detection. The results of the present study demonstrated echocardiographic changes in patients with end stage renal disease in the form of significant increase in inter-ventricular septal diameter [IVSD], posterior wall thickness [PWT], left ventricular mass index [LVMI], velocity of circumferential fiber shortening [vCFS], and isovolumetric relaxation time [IVRT], [P<0.001, P<0.001, P<0.01 and P<0.001 resespectively] as well as significant decrease of e/a ratio [P<0.001] as compared to the controls. Furthermore, there was significant increase of LVMI in hypertensives as compared to normotensives [P<0.001]. CRP measured by latex agglutination was significantly increased in patients as compared to controls [+ve in 17 patients, 13 were hypertensive and 4 were normotensive], it was correlated inversely with body mass index [P<0.05] and directly with LVMI [P<0.05]. The highly sensitive [hs] CRP was also significantly elevated in patients than controls [+ve in 21 patients, 12 were hypertensive and 9 were normotensive, with median of 31.35 micro g/ml and IQR of 33.028] [P<0.001], it was significantly higher in patients with cardiovascular events [P<0.001] and those with lowered e/a ratio[P<0.05] and the level was affected by S. Ca, S.p and CaXP products[P<0.01]. The only mortality during this study demonstrated high levels of conventional and [hs] CRP. LV hypertrophy and diastolic dysfunction are the main CV changes in children with ESRD. There is high prevalence of inflammation related mainly to the BMI and CaXp products but not to the usual lipid risk factors. This inflammation [as detected by conventional and [hs] CRP] can help in prediction of LV structural and functional abnormalities