TITLE:
Evaluating Growth Differentiation Factor-15 Serum Levels and Left Ventricular Dysfunction Using Different Techniques in Pediatric Hemodialysis Patients
AUTHORS:
Manal Abd El-Salam, Fatma Abdullaha, Eglal Hussein, Tagreed Abdel-Rahman, Nadia Youssef
KEYWORDS:
Hemodialysis, Children, GDF-15, Speckled Tracking Echo
JOURNAL NAME:
Open Journal of Nephrology,
Vol.14 No.4,
October
30,
2024
ABSTRACT: Background: The standard echocardiography is limited in detecting subclinical left ventricular (LV) dysfunction in pediatric hemodialysis patients. However, speckle-tracking echo (STE) analysis has emerged as a viable alternative. Furthermore, Growth Differentiation Factor-15 (GDF-15) is a stress-responsive biomarker generated by cardiac tissues. Aim: Evaluate left ventricular function using a range of echocardiography modalities and determine the most effective modality. Additionally, it seeks to quantify the diagnostic accuracy of GDF-15 as an early indicator of cardiac dysfunction in pediatric patients undergoing regular hemodialysis and explore the association between GDF-15 levels and left ventricular dysfunction. Subjects and Methods: An assessment of the LV functions and dimensions in a cohort of 40 pediatric patients undergoing regular hemodialysis compared to a control group of 40 healthy children. Our evaluation encompassed the utilization of GDF-15, hsCRP serum levels, conventional Echocardiography, tissue Doppler imaging (TDI), and Speckle Tracking Echocardiography (STE), in conjunction with routine laboratory investigations, to analyze the subjects post-hemodialysis (HD). Results: Children on hemodialysis showed significantly higher levels of GDF-15 and hsCRP. Furthermore, 67.5% of the patients displayed impaired left ventricular function as identified through conventional and TDI, while 82.5% exhibited global left ventricular strain as determined by STE. A strong correlation was found between EF% and serum cholesterol and triglyceride levels. Additionally, a notable association was discovered between GDF-15 and systolic blood pressure, left ventricular interventricular septal diameter (LVIVSD), and serum calcium levels. Conclusion: STE has shown its superiority over conventional and (TDI) in the early identification of LV changes in pediatric hemodialysis patients. GDF-15 is a sensitive indicator for early left ventricular dysfunction and shows a significant correlation with hypertension, left ventricular interventricular septal end-diastolic dimension (LVIVSD), and serum calcium levels.