Abstract 146 Poster Session III, Monday, 5/3 (poster 129)

Cardiovascular abnormalities strongly affect morbidity and mortality in pts with chronic renal failure (CRF). It has been questioned whether elevated serum cardiac troponin (cTnT) is associated with myocardial injury in pts with CRF. Because pediatric pts with CRF have fewer risk factors than adults for heart disease other than those related to uremia, myocardial injury is more likely to be related to uremia or to treatment of kidney failure in these pts. Age- or body-surface-area-adjusted echo measurements, serum cTnT and other blood tests were obtained from 50 pediatric patients with CRF and without CHF, including 27 on hemodialysis to determine the extent of cardiac involvement and the significance of elevations of cTnT. Cardiovascular abnormalities were nearly universal (49 of 50 pts), including increased LV function, LV mass, heart rate, and blood pressure and reduced LV afterload. Myocardial injury was noted with elevations of serum cTnT in most pts on hemodialysis. In multivariate analyses, higher cTnT correlated with higher CK-MB mass, lower LV contractility, lower serum PTH, higher BUN, higher bicarbonate, and the use of diuretics, but not higher cTnI elevations. There was an inverse relation between LV contractility and serum creatinine and phosphorus and use of beta blockers. In conclusion, subclinical cardiovascular abnormalities are common in pediatric pts with CRF, and may be related to loading condition and autonomic abnormalities. Although LV performance is maintained, evidence of myocardial injury is common and is related to abnormalities in calcium and phosphorus metabolism, uremic compounds and bicarbonate. The prevention of chronic myocardial injury by modification of cardiac risk factors may reduce subsequent cardiovascular morbidity and mortality in this high-risk population.