Fig. 2

Cardiac adaptation in paediatric chronic kidney disease. Left ventricular adapts through concentric and eccentric geometry patterns in response to increasing afterload and preload. Afterload increases because of a higher systemic arterial resistance, due to hypertension, and a reduced large-vessel compliance, resulting in an increase of the left ventricular wall thickness and therefore in a concentric left ventricular hypertrophy. Preload increases because of intravascular volume expansion, due to volume overload, anaemia and even the presence of an arteriovenous fistula, leading to eccentric hypertrophy. In addition, oxidative stress, enhanced renin–angiotensin–aldosterone system activation, and chronic inflammation have been shown to be responsible for LVH in murine models. Abbreviations: BMI, body mass index; CO, cardiac output; CR, cardiorespiratory; Hgb, haemoglobin; HTN, hypertension; LV, left ventricular; LVMI, left ventricular mass index; PTH, parathyroid hormone; RAAS, renin-aldosterone-angiotensin system