Diagnosis of cardiac disease in pediatric end-stage renal disease

Blanche M. Chavers, Craig A. Solid, Alan Sinaiko, Frank X. Daniels, Shu Cheng Chen, Allan J. Collins, Diane L. Frankenfield, Charles A. Herzog

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background. Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). This study aimed to report the frequency of cardiac disease diagnostic methods used in US pediatric maintenance hemodialysis patients.Methods. A cross-sectional analysis of all US pediatric (ages 0.718 years, n = 656) maintenance hemodialysis patients was performed using data from the Centers for Medicare and Medicaid Services ESRD Clinical Performance Measures Project. Clinical and laboratory information was collected in 2001. Results were analysed by age, sex, race, Hispanic ethnicity, dialysis duration, body mass index (BMI), primary ESRD cause and laboratory data.Results. Ninety-two percent of the patients had a cardiovascular risk factor (63% hypertension, 38% anemia, 11% BMI > 94th percentile, 63% serum phosphorus > 5.5 mg/dL and 55% calciumphosphorus product < 55 mg 2/dL2). A diagnosis of cardiac disease was reported in 24% (n = 155) of all patients: left ventricular hypertrophy/enlargement 17%, congestive heart failure/pulmonary edema 8%, cardiomyopathy 2% and decreased left ventricular function 2%. Thirty-one percent of patients were not tested. Of those tested, the diagnostic methods used were chest X-rays in 60%, echocardiograms in 35% and electrocardiograms in 33%; left ventricular hypertrophy/enlargement was diagnosed using echocardiogram (72%), chest X-ray (20%) and electrocardiogram (15%).Conclusions. Although 92% of patients had cardiovascular risk factors, an echocardiography was performed in only one-third of the patients. Our study raises the question of why echocardiography, considered the gold standard for cardiac disease diagnosis, has been infrequently used in pediatric maintenance dialysis patients, a high-risk patient population.

Original languageEnglish (US)
Pages (from-to)1640-1645
Number of pages6
JournalNephrology Dialysis Transplantation
Issue number5
StatePublished - May 2011

Bibliographical note

Funding Information:
Acknowledgements. This study was performed as a deliverable under Contract No. HHSN267200715003C (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA). The authors thank USRDS colleagues Beth Forrest for regulatory assistance, Shane Nygaard for manuscript preparation and submission assistance, and Nan Booth, MSW, MPH, for editorial assistance.


  • cardiac disease
  • end-stage renal disease
  • hypertension
  • maintenance hemodialysis
  • pediatric


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