Cheang, Mun Hong; (2018) Comprehensive cardiovascular phenotyping of children with renal disease. Doctoral thesis (M.D(Res)), UCL (University College London).

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Abstract

Children with chronic kidney disease (CKD) have significantly increased cardiovascular mortality. The reasons for this remain unclear, as the pathological effects of renal disease have not been well characterised. This is because current methods of assessment like echocardiography have significant limitations. Cardiovascular magnetic resonance imaging (CMR) is the reference standard method for cardiovascular assessment. Therefore, the aim of this thesis is to investigate the utility of CMR for the cardiovascular assessment of children with renal disease. Three separate studies were carried out to comprehensively characterise the cardiovascular phenotype in the following groups: pre-dialysis CKD, dialysis dependent CKD and renovascular hypertension. They were compared with a control group of healthy and essential hypertension children. All subjects underwent a CMR study with non-invasive blood pressure measurements. The protocol included novel sequences that assessed diastolic function and myocardial velocity, in addition to conventional measures. Between group ANOVA comparisons were performed as described; mild, moderate and severe pre-dialysis CKD (n=100) versus healthy children (n=20), Haemodialysis (n=9), peritoneal dialysis (n=8), pre-dialysis CKD stage 5 (n=10) versus healthy children (n=10), and renovascular hypertension (n=15), essential hypertension (n=15) versus healthy children (n=15).Blood pressure and systemic vascular resistance (SVR) were elevated while total arterial compliance was normal in all renal patients. There was also evidence of left ventricular remodelling without hypertrophy in pre-dialysis and renovascular children. Diastolic dysfunction was present in all renal patients. Systolic myocardial velocity was impaired only in CKD but not in renovascular hypertension. In conclusion, CMR offers valuable insight into the cardiovascular characteristics of renal disease. Hypertension in renal disease is predominantly secondary to elevated SVR. Diastolic impairment preceded left ventricular hypertrophy. Sub-clinical systolic dysfunction was also present in renal dysfunction. Further studies are warranted to investigate the future role of CMR for cardiovascular risk assessment in paediatric renal disease.

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