Cardiovascular complications are a leading cause of morbidity and mortality in children with chronic kidney disease (CKD) undergoing hemodialysis. Left ventricular hypertrophy (LVH) and diastolic dysfunction are frequently observed in this population, while the role of nitric oxide (NO) in cardiac remodeling remains insufficiently clarified. The aim of this study was to evaluate the association between nitric oxide levels and left ventricular diastolic function in pediatric patients on chronic hemodialysis, as well as to assess the effects of erythropoietin therapy.
This prospective study included 30 children (mean age 13.6 ± 1.3 years) undergoing chronic hemodialysis. All patients received recombinant human erythropoietin (rHuEpo) therapy over a period of 6 months. Echocardiographic parameters, including left ventricular mass index (LVMI) and diastolic function (E/A ratio), were assessed, and nitric oxide levels were measured using a colorimetric method.
Following rHuEpo therapy, a significant reduction in LVMI was observed (p < 0.008), indicating regression of LVH. However, diastolic function worsened, with a mean E/A ratio of 0.83 (p = 0.007). Nitric oxide levels were 11.8% higher in patients with LVH and decreased after therapy in parallel with the reduction in LVMI. Significant positive correlations were found between NO and LVMI, as well as between NO and E/A ratio, while a negative, non-significant correlation was observed between NO and hemoglobin.
In conclusion, erythropoietin therapy in pediatric hemodialysis patients improves cardiac structure but may adversely affect diastolic function. Nitric oxide appears to play an important role in this complex interaction, highlighting the need for comprehensive cardiovascular assessment in this population.
