Left ventricular remodeling by cardiac magnetic resonance in children with advanced chronic kidney disease: an analysis of the Chronic Kidney Disease in Children (CKiD) study

Children with advanced chronic kidney disease (CKD) have a high burden of cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) and abnormal myocardial strain are prevalent in CKD patients and confer increased cardiovascular morbidity. While echocardiography is conventionally used to assess myocardial function, cardiovascular magnetic resonance imaging (CMR) provides superior assessment of myocardial morphology and function, including myocardial strain. We conducted an exploratory analysis of the CMR features of children with advanced CKD in the Chronic Kidney Disease in Children (CKiD) study to evaluate the relationship between CKD and CVD severity. A subset of CKiD patients with eGFR < 30 ml/min/1.73 m 2 underwent CMR. Left ventricular mass indexed to body surface area (LV mass index), global peak longitudinal strain (GLS), and global peak circumferential strain (GCS) were the primary continuous outcomes. We quantified associations between clinical/demographic risk factors with LV mass index, GLS, and GCS using linear regression, and utilized a variant of stepwise regression to identify combinations of independent variables that were most associated with the primary outcomes. We analyzed 47 CKiD participants (median age, 16 years; median eGFR, 25 ml/min|1.73 m 2 ). LVH was prevalent at 13%. GLS and GCS > 95th percentile of published normative thresholds was prevalent at 60% and 68%, respectively. Only 6% of participants had clinically significant abnormally low absolute GLS (< 15). Lower GLS and GCS were independently associated with higher LV mass index. Myocardial strain > 95th percentile of published normal thresholds on CMR was highly prevalent and related to higher LV mass index in the CKiD cohort with advanced CKD. A higher resolution version of the Graphical abstract is available as Supplementary information