Background: Fluid overload in children undergoing dialysis can lead to serious cardiac complications, i.e., left ventricular hypertrophy (LVH) and cardiac dysfunction. Studies investigating the cardiovascular effects of persistent subclinical hypervolemia-characterized by euvolemia at clinical assessment but hypervolemia at technical evaluation-are lacking. This pilot study explored the combined use of lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of the inferior vena cava collapsibility index (IVC-CI) to identify subclinical hypervolemia and investigated its cardiac impact. Methods: In this longitudinal study, we recruited 23 children on chronic dialysis who underwent fluid status evaluation (physical examination, LUS, IVC-CI, BIS) every 2 months and echocardiography every 6 months. Results: In clinically euvolemic patients, we observed a significant positive correlation between the interdialytic weight gain and the number of B-lines observed by LUS (R = 0.2923, p < 0.001); similar results were obtained for the OH/ECW measured by BIS (R = 0.4144, p < 0.001), while a negative correlation with IVC-CI (R = - 0.2597, p = 0.019) was observed. Moreover, we identified a significant linear correlation between left ventricular mass index values and the average pre-dialysis systolic blood pressure measured over the preceding 6 months (R2 = 0.16, p = 0.002). Hospitalizations due to hypertensive crises (67% vs. 0%, p < 0.01) and the occurrence of LVH at the final follow-up (75% vs. 27%, p = 0.04) were notably more frequent in children with subclinical hypervolemia. Conclusion: In clinically euvolemic children on dialysis, the combined use of LUS, BIS, and IVC-CI (multiparametric approach) effectively quantified subclinical hypervolemia, which was correlated with the risk of LVH.
Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left ventricular hypertrophy in clinically euvolemic children on dialysis: a prospective longitudinal pilot study
Farella, Ilaria;
2026-01-01
Abstract
Background: Fluid overload in children undergoing dialysis can lead to serious cardiac complications, i.e., left ventricular hypertrophy (LVH) and cardiac dysfunction. Studies investigating the cardiovascular effects of persistent subclinical hypervolemia-characterized by euvolemia at clinical assessment but hypervolemia at technical evaluation-are lacking. This pilot study explored the combined use of lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of the inferior vena cava collapsibility index (IVC-CI) to identify subclinical hypervolemia and investigated its cardiac impact. Methods: In this longitudinal study, we recruited 23 children on chronic dialysis who underwent fluid status evaluation (physical examination, LUS, IVC-CI, BIS) every 2 months and echocardiography every 6 months. Results: In clinically euvolemic patients, we observed a significant positive correlation between the interdialytic weight gain and the number of B-lines observed by LUS (R = 0.2923, p < 0.001); similar results were obtained for the OH/ECW measured by BIS (R = 0.4144, p < 0.001), while a negative correlation with IVC-CI (R = - 0.2597, p = 0.019) was observed. Moreover, we identified a significant linear correlation between left ventricular mass index values and the average pre-dialysis systolic blood pressure measured over the preceding 6 months (R2 = 0.16, p = 0.002). Hospitalizations due to hypertensive crises (67% vs. 0%, p < 0.01) and the occurrence of LVH at the final follow-up (75% vs. 27%, p = 0.04) were notably more frequent in children with subclinical hypervolemia. Conclusion: In clinically euvolemic children on dialysis, the combined use of LUS, BIS, and IVC-CI (multiparametric approach) effectively quantified subclinical hypervolemia, which was correlated with the risk of LVH.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
