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Ferraro S, Benedetti S, Mannarino S, Marcovina S, Mario Biganzoli E, Zuccotti G. Prediction of atherosclerotic cardiovascular risk in early childhood. Clin Chim Acta 2024; 552:117684. [PMID: 38016628 DOI: 10.1016/j.cca.2023.117684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023]
Abstract
Atherosclerotic lesions are present even in very young individuals and therefore, risk stratification for cardiovascular (CV) disease should be implemented in childhood to promote early prevention strategies. In this review we critically appraise clinical, biochemical and genetic biomarkers available for pediatric clinical practice, which might be integrated to build effective algorithms to identify children at risk of future CV events. The first critical issue is to characterize in children aged 2-5 years, those CV risk factors/clinical conditions associated with dramatically accelerated atherosclerosis. Presence of clinical conditions such as obesity, diabetes mellitus, Kawasaki disease, etc., or positive family history for premature CV disease should be evaluated. Subsequently, a complete lipid profile and Lipoprotein(a) determination are recommended for children with increased baseline CV risk. Individuals with altered lipid profile could then undergo genetic testing for monogenic dyslipidemias to identify children with high CV genetic risk, who will be directed to appropriate therapeutic options. In perspective, calculation of a polygenic risk score, based on the analysis of several common single-nucleotide polymorphisms, could be integrated for better risk assessment. We here emphasize the importance of a "holistic" strategy integrating biochemical, anamnestic and genetic data to stratify CV risk in early childhood.
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Affiliation(s)
- Simona Ferraro
- Center of Functional Genomics and Rare Diseases Dept. of Pediatrics Buzzi Children's Hospital, Milan, Italy; Pediatric Department, Buzzi Children's Hospital, Milan, Italy.
| | - Sara Benedetti
- Center of Functional Genomics and Rare Diseases Dept. of Pediatrics Buzzi Children's Hospital, Milan, Italy; Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milano, Italy
| | | | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy; Data Science Research Center, University of Milan, Milan, Italy.
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy; Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
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2
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Močnik M, Golob Jančič S, Marčun Varda N. Liver and kidney ultrasound elastography in children and young adults with hypertension or chronic kidney disease. Pediatr Nephrol 2023; 38:3379-3387. [PMID: 37154960 DOI: 10.1007/s00467-023-05984-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Ultrasound elastography is a research method increasingly used to measure tissue elasticity. The aim of the study was to assess its usability in pediatric patients with either chronic kidney disease (CKD) or hypertension. METHODS A total of 46 patients with CKD (group 1), 50 patients with hypertension (group 2), and 33 healthy participants as the control group were included. In all, we performed studies assessing their cardiovascular risk along with liver and kidney elastography. RESULTS Liver elastography parameters were increased compared to those in the control group (1.49 m/s, p = 0.007, in group 1 and 1.52 m/s, p < 0.001, in group 2, vs. 1.41 m/s among controls). Kidney elastography parameters were significantly higher in group 2 (1.9 m/s, p = 0.001, and 1.9 m/s, p = 0.003, in each kidney) when compared to group 1 (1.79 m/s and 1.81 m/s). Additionally, all participants were divided according to overweight/obesity and normal weight status, where both liver (1.53 m/s vs. 1.45 m/s, p < 0.001) and kidney parameters (1.96 m/s and 1.92 m/s vs. 1.81 m/s and 1.84 m/s, p = 0.002) were significantly higher in the group of overweight/obese subjects. CONCLUSIONS Ultrasound elastography of the liver and kidney is feasible in pediatric patients with either CKD or hypertension, showing increased liver stiffness parameters in both groups, further aggravated by obesity. In obese patients with CKD, kidney stiffness also increased indicating a negative effect of clustering cardiovascular risk factors leading to decreased kidney elasticity. Further research is warranted. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mirjam Močnik
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia.
| | - Sonja Golob Jančič
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia
| | - Nataša Marčun Varda
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska 8, 2000, Maribor, Slovenia
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3
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Tran AH, Urbina EM. Is There a Role for Imaging Youth at Risk of Atherosclerosis? Curr Atheroscler Rep 2023; 25:119-126. [PMID: 36848015 DOI: 10.1007/s11883-023-01089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular (CV) risk factors such as dyslipidemia, hypertension, diabetes, and obesity are associated with an increased risk for CV events in adults. Noninvasive measures of vascular health are associated with these CV events and can potentially help risk stratify children with CV risk factors. The purpose of this review is to summarize recent literature regarding vascular health in children with cardiovascular risk factors. RECENT FINDINGS Adverse changes in pulse wave velocity, pulse wave analysis, arterial distensibility, and carotid intima-media thickness are seen in children with CV risk factors supporting potential utility in risk stratification. Assessing vascular health in children can be challenging due to growth-related changes in vasculature, multiple assessment modalities, and differences in normative data. Vascular health assessment in children with cardiovascular risk factors can be a valuable tool for risk stratification and help identify opportunities for early intervention. Future areas of research include increasing normative data, improving conversion of data between different modalities, and increasing longitudinal studies in children linking childhood risk factors to adult CV outcomes.
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Affiliation(s)
- Andrew H Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7002, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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Ferraro S, Biganzoli G, Calcaterra V, Zuccotti G, Biganzoli EM, Plebani M. Fibroblast growth factor 23: translating analytical improvement into clinical effectiveness for tertiary prevention in chronic kidney disease. Clin Chem Lab Med 2022; 60:1694-1705. [PMID: 36008874 DOI: 10.1515/cclm-2022-0635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Fibroblast growth factor 23 (FGF23) plays a key role in the pathophysiology of chronic kidney disease (CKD) and of the associated cardiovascular diseases, ranking on the crossroads of several evolving areas with a relevant impact on the health-care system (ageing, treatment of CKD and prevention from cardiovascular and renal events). In this review, we will critically appraise the overall issues concerning the clinical usefulness of FGF23 determination in CKD, focusing on the analytical performances of the methods, aiming to assess whether and how the clinical introduction of FGF23 may promote cost-effective health care policies in these patients. CONTENT Our comprehensive critical appraisal of the literature revealed that we are currently unable to establish the clinical usefulness of FGF23 measured by ELISA in CKD, as stability issues and suboptimal analytical performances are the major responsible for the release of misleading results. The meta-analytical approach has failed to report unambiguous evidence in face of the wide heterogeneity of the results from single studies. SUMMARY AND OUTLOOK Our review has largely demonstrated that the clinical usefulness depends on a thorough analytical validation of the assay. The recent introduction of chemiluminescent intact-FGF23 (iFGF23) assays licensed for clinical use, after passing a robust analytical validation, has allowed the actual assessment of preliminary risk thresholds for cardiovascular and renal events and is promising to capture the iFGF23 clinically relevant changes as a result of a therapeutic modulation. In this perspective, the analytical optimization of FGF23 determination may allow a marriage between physiology and epidemiology and a merging towards clinical outcomes.
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Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Department, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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Brecheret AP, Abreu ALCS, Lopes R, Fonseca FAH, Solé D, Andrade MCD. Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease. EINSTEIN-SAO PAULO 2022; 20:eAO6758. [PMID: 35544895 PMCID: PMC9070993 DOI: 10.31744/einstein_journal/2022ao6758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/30/2021] [Indexed: 11/07/2022] Open
Abstract
Objective Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. Methods In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles. Results The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). Conclusion Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.
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Filip C, Cirstoveanu C, Bizubac M, Berghea EC, Căpitănescu A, Bălgrădean M, Pavelescu C, Nicolescu A, Ionescu MD. Pulse Wave Velocity as a Marker of Vascular Dysfunction and Its Correlation with Cardiac Disease in Children with End-Stage Renal Disease (ESRD). Diagnostics (Basel) 2021; 12:diagnostics12010071. [PMID: 35054238 PMCID: PMC8774385 DOI: 10.3390/diagnostics12010071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022] Open
Abstract
One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.
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Affiliation(s)
- Cristina Filip
- Pediatric Cardiology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.F.); (A.N.)
| | - Cătălin Cirstoveanu
- Neonatal Intensive Care Unit, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Correspondence:
| | - Mihaela Bizubac
- Neonatal Intensive Care Unit, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Elena Camelia Berghea
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.B.); (M.B.)
- Allergology and Clinical Immunology Department, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Andrei Căpitănescu
- Pediatric Hemodialysis, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Mihaela Bălgrădean
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.B.); (M.B.)
- Pediatrics and Pediatric Nephrology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Carmen Pavelescu
- Pediatrics and Pediatric Nephrology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Alin Nicolescu
- Pediatric Cardiology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.F.); (A.N.)
| | - Marcela Daniela Ionescu
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Pediatrics and Pediatric Pulmonology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
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Végh A, Bárczi A, Cseprekál O, Kis É, Kelen K, Török S, Szabó AJ, Reusz GS. Follow-Up of Blood Pressure, Arterial Stiffness, and GFR in Pediatric Kidney Transplant Recipients. Front Med (Lausanne) 2021; 8:800580. [PMID: 34977101 PMCID: PMC8716619 DOI: 10.3389/fmed.2021.800580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Pediatric renal transplant recipients (RTx) were studied for longitudinal changes in blood pressure (BP), arterial stiffness by pulse wave velocity (PWV), and graft function. Patients and Methods: 52 RTx patients (22 males) were included; office BP (OBP) and 24 h BP monitoring (ABPM) as well as PWV were assessed together with glycemic and lipid parameters and glomerular filtration rate (GFR) at 2.4[1.0–4.7] (T1) and 9.3[6.3–11.8] years (T2) after transplantation (median [range]). Results: Hypertension was present in 67 and 75% of patients at T1 and T2, respectively. Controlled hypertension was documented in 37 and 44% by OBP and 40 and 43% by ABPM. Nocturnal hypertension was present in 35 and 30% at T1 and T2; 24 and 32% of the patients had masked hypertension, while white coat hypertension was present in 16 and 21% at T1 and T2, respectively. Blood pressure by ABPM correlated significantly with GFR and PWV at T2, while PWV also correlated significantly with T2 cholesterol levels. Patients with uncontrolled hypertension by ABPM had a significant decrease in GFR, although not significant with OBP. Anemia and increased HOMAi were present in ~20% of patients at T1 and T2. Conclusion: Pediatric RTx patients harbor risk factors that may affect their cardiovascular health. While we were unable to predict the evolution of renal function based on PWV and ABPM at T1, these risk factors correlated closely with GFR at follow-up suggesting that control of hypertension may have an impact on the evolution of GFR.
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Affiliation(s)
- Anna Végh
- First Department of Pediatrics Semmelweis University, Budapest, Hungary
| | - Adrienn Bárczi
- Medical Imaging Centre Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Transplantation and Surgery Semmelweis University, Budapest, Hungary
| | - Éva Kis
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Kata Kelen
- First Department of Pediatrics Semmelweis University, Budapest, Hungary
| | - Szilárd Török
- Department of Transplantation and Surgery Semmelweis University, Budapest, Hungary
| | - Attila J. Szabó
- First Department of Pediatrics Semmelweis University, Budapest, Hungary
| | - György S. Reusz
- First Department of Pediatrics Semmelweis University, Budapest, Hungary
- *Correspondence: György S. Reusz
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Azukaitis K, Jankauskiene A, Schaefer F, Shroff R. Pathophysiology and consequences of arterial stiffness in children with chronic kidney disease. Pediatr Nephrol 2021; 36:1683-1695. [PMID: 32894349 DOI: 10.1007/s00467-020-04732-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
Changes in arterial structure and function are seen early in the course of chronic kidney disease (CKD) and have been causally associated with cardiovascular (CV) morbidity. Numerous potential injuries encompassing both traditional and uremia-specific CV risk factors can induce structural arterial changes and accelerate arterial stiffening. When the buffering capacity of the normally elastic arteries is reduced, damage to vulnerable microcirculatory beds can occur. Moreover, the resultant increase to cardiac afterload contributes to the development of left ventricular hypertrophy and cardiac dysfunction. Adult studies have linked arterial stiffness with increased risk of mortality, CV events, cognitive decline, and CKD progression. Pulse wave velocity (PWV) is currently the gold standard of arterial stiffness assessment but its measurement in children is challenging due to technical difficulties and physiologic aspects related to growth and poor standardization between algorithms for calculating PWV. Nevertheless, studies in pediatric CKD have reported increased arterial stiffness in children with advanced CKD, on dialysis, and after kidney transplantation. Development of arterial stiffness in children with CKD is closely related to mineral-bone disease and hypertension, but other factors may also play a significant role. The clinical relevance of accelerated arterial stiffness in childhood on cardiovascular outcomes in adult life remains unclear, and prospective studies are needed. In this review we discuss mechanisms leading to arterial stiffness in CKD and its clinical implications, along with issues surrounding the technical aspects of arterial stiffness assessment in children.
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Affiliation(s)
- Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 4, 08406, Vilnius, Lithuania.
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 4, 08406, Vilnius, Lithuania
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Institute of Child Health, London, UK
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Augmentation index, a predictor of cardiovascular events, is increased in children and adolescents with primary nephrotic syndrome. Pediatr Nephrol 2020; 35:815-827. [PMID: 31845056 DOI: 10.1007/s00467-019-04434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Arterial stiffness is associated with an increased risk of cardiovascular diseases. Augmentation index (AIx@75), a measure of arterial stiffness and wave reflection, has not been evaluated in patients with primary nephrotic syndrome (PNS). We investigated whether central and peripheral vascular profiles, hemodynamic parameters, and biochemical tests are associated with AIx@75 in PNS patients. METHODS This observational study involved 38 children and adolescents with PNS (12.14 ± 3.65 years) and 37 healthy controls (13.28 ± 2.80 years). Arterial stiffness and vascular and hemodynamic parameters were measured noninvasively using the Mobil-O-Graph® (IEM, Stolberg, Germany). In the PNS group, biochemical tests and corticosteroid dosage/treatment time were analyzed. RESULTS Peripheral and central systolic blood pressure (SBPp, SBPc) Z-scores were significantly higher in the PNS patients. AIx@75 was significantly higher in the PNS patients (25.14 ± 9.93%) than in controls (20.84 ± 7.18%). In the control group, AIx@75 negatively correlated with weight (r = - 0.369; p = 0.025), height (r = - 0.370; p = 0.024), and systolic volume/body surface (r = - 0.448; p = 0.006). In the PNS group, a univariate linear correlation showed that AIx@75 negatively correlated with weight (r = - 0.360; p = 0.027), height (r = 0.381; p = 0.18), and systolic volume/body surface (r = - 0.447; p < 0.002) and positively with the Z-score of SBPp (r = 0.407; p = 0.011), peripheral diastolic blood pressure (DBPp, r = 0.452; p = 0.004), SBPc (r = 0.416; p = 0.009), DBPc (r = 0.407; p = 0.011), triglycerides (r = 0.525; p = 0.001), and cholesterol [total (r = 0.539; p < 0.001), LDLc (r = 0.420; p = 0.010), and non-HDLc (r = 0.511; p = 0.001)]. CONCLUSIONS Early abnormalities of AIx@75 and vascular parameters suggest that patients with PNS, even in stable condition, present subclinical indicators for the development of cardiovascular disease.
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Ambulatory blood pressures and central blood pressures are associated with cardiovascular morbidity in adolescent and young adult patients receiving chronic hemodialysis. Pediatr Nephrol 2019; 34:1261-1268. [PMID: 30778828 DOI: 10.1007/s00467-019-04208-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/16/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) and arterial stiffness measured by pulse wave velocity (PWV) are independent predictors of cardiovascular (CV) mortality in adults receiving chronic dialysis. Hypertension strongly associates with elevated left ventricular mass index (LVMI) and PWV, with ambulatory blood pressure monitoring (ABPM), and central blood pressure (CBP) superior to office blood pressures (BP) in predicting CV morbidity. Few studies have described associations of office BP, ABPM, and CBP with LVMI and PWV in adolescent and young adult patients receiving hemodialysis (HD). METHODS Cross-sectional study of 22 adolescents and young adults receiving chronic HD. Pre- and post-dialysis office BP and CBP using applanation tonometry were obtained. Twenty-four-hour ABPM was obtained midweek post-dialysis. Pre- and post-dialysis carotid-brachial PWV were obtained same day as BP measurements. Annual echocardiograms for standard care were reviewed for LVH. RESULTS Pre-dialysis CBP index correlated with LVMI (r = 0.3, p = 0.04) and PWV (r = 0.48, p = 0.02). Hypertensive patients identified by ABPM had worse LVMI; daytime ABPM systolic BP index correlated with LVMI (r = 0.5, p = 0.02). Office BP was not associated with LVMI; only office diastolic BP was associated with PWV (r = 0.46, p = 0.02). There was no correlation of LVMI or PWV with bone health parameters, anemia, interdialytic weight gain, or residual renal function. CONCLUSIONS Ambulatory blood pressure monitoring is superior to casual office BP obtained at time of dialysis in delineating cardiovascular morbidity in adolescent and young adult HD patients. CBP is easily performed and correlates with LVMI and PWV in adolescent and young adult HD patients; however, large-scale normative data is needed.
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11
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Zheng J, Nakamura T, Lu N, Hori K, Oguri M, Sakurai M, Ishizaki M. The radial augmentation index in children with Kawasaki disease without acute coronary artery lesions during the convalescent period. Ther Clin Risk Manag 2019; 15:701-709. [PMID: 31354277 PMCID: PMC6580131 DOI: 10.2147/tcrm.s208632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/20/2019] [Indexed: 01/09/2023] Open
Abstract
Purpose We recently reported that children and adolescents with a history of Kawasaki disease (KD) had slight but significant elastic arterial stiffness even when no coronary artery lesions (CALs) were present. Moreover, we hypothesized that KD-related arteriopathy may also cause peripheral artery dysfunction. The objective of this study was to assess the involvement of radial artery pulse waves, especially reflection waves from the peripheral arteries using the radial artery augmentation index (rAI) in patients without CALs after KD. Materials and methods We first collected the rAI data from 312 subjects (149 consecutive patients of KD and 163 control subjects). Next, 225 cases between 6 and 15 years old were selected. Finally, 41 pairs were included for analysis. The rAI values of these two groups were compared and analyzed. Acute-phase data were also collected to reveal the possible correlation with rAI in the convalescent period. Results Multivariable analysis revealed the history of KD was positively correlated with rAI@75 value in children from 6 to 15 years old. After pairing the height and gender, the KD group also had significantly higher rAI and rAI@75 than the control group (rAI 60.63±13.77 vs 54.56±13.17, p=0.028; rAI@75 63.61±15.21 vs 55.68±14.86, p=0.003). With regard to acute-phase condition, nonresponse to initial treatment was also linked to elevated rAI during the convalescent period. Conclusions During the convalescent period, the rAI increased in KD patients without acute CALs. Furthermore, nonresponse to initial treatment in acute phase conferred higher rAI to KD subjects than respondent cases. Elevated rAI means the reflection wave from the peripheral vascular is stronger or earlier. This small but significant change may indicate the existence of peripheral artery stiffness during the convalescent period.
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Affiliation(s)
- Jianbo Zheng
- Department of Pediatric Cardiology, Kanazawa Medical University, Ishikawa, Japan.,Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tsuneyuki Nakamura
- Department of Pediatric Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Na Lu
- Department of Pediatric Cardiology, Kanazawa Medical University, Ishikawa, Japan.,Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Kaori Hori
- Department of Pediatric Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Masato Oguri
- Department of Pediatric Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Masaru Sakurai
- Department of Hygiene, Kanazawa Medical University, Ishikawa, Japan
| | - Masao Ishizaki
- Department of Hygiene, Kanazawa Medical University, Ishikawa, Japan
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12
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Karava V, Benzouid C, Kwon T, Macher MA, Deschênes G, Hogan J. Interdialytic weight gain and vasculopathy in children on hemodialysis: a single center study. Pediatr Nephrol 2018; 33:2329-2336. [PMID: 30178237 DOI: 10.1007/s00467-018-4026-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/04/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increased interdialytic weight gain (IDWG) has been associated with poor outcomes in adults, but its impact on hemodialysis vasculopathy in children is unknown. METHODS Nineteen patients (age 9 to 19 years old) with a median hemodialysis duration of 10.4 months were enrolled. Cardiovascular evaluation included left ventricular mass index (LVMI), pulse wave velocity (PWV), and carotid intima-media thickness (cIMT) measurements. PWV and cIMT were expressed as z-scores based on reference values in healthy children. Blood pressure (BP) evaluation consisted in a 24-h ambulatory BP monitoring. Mean IDGW and residual urine output during the 6 months prior to cardiovascular examination were calculated. RESULTS Increased cIMT, LVMI, and PWV was observed in 11 (57.9%), 7 (36.8%), and 5 (26.3%) patients respectively, while BP was normal in all patients. Median IDWG was 3.5% (1.8-6.7). Residual urine output and BP status did not significantly differ between patients with IDWG ≥ or < 4%. After linear regression, IDWG was correlated to cIMT z-score (r2 = 0.485, p = 0.001), but not to PWV z-score (r2 = 0.04, p = 0.415) and LVMI (r2 = 0.092, p = 0.206). After univariate logistic regression, IDWG ≥ 4% was significantly associated to increased cIMT (above 1.65 SDS) (odds ratio 12.25, 95% confidence interval 1.08-138.988). The trend toward an increased cIMT with IDWG ≥ 4% was observed in both patients with short and long dialysis vintage. CONCLUSIONS High IDWG is associated with increased cIMT in hemodialyzed children independently of BP control and dialysis vintage. This observation reinforces the importance of interventions to avoid IDWG in hemodialyzed children.
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Affiliation(s)
- Vasiliki Karava
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France.
| | - Cherine Benzouid
- Pediatric Cardiology Department, Robert Debré Hospital, APHP, Paris, France
| | - Theresa Kwon
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Marie-Alice Macher
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
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13
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Abstract
PURPOSE OF REVIEW Hypertension is an independent risk factor for progression of chronic kidney disease (CKD) in children. Children with early CKD develop hypertension secondary to renal disease. This review aims to highlight recent advances that help us better understand the current role of hypertension in progression of CKD in children. RECENT FINDINGS There is increasing evidence that children with CKD who have hypertension develop early atherosclerosis and cardiac adaptive changes. Emerging data from pediatric research in CKD show that elevated blood pressure is associated with the presence of abnormal subclinical markers of cardiovascular disease including increased carotid intima-media thickness, pulse wave velocity and left ventricular mass index. There is also some evidence that these early cardiovascular changes are reversible. Twenty-four hour ambulatory blood pressure monitoring (ABPM) is recommended in children with CKD by the American Academy of Pediatrics to diagnose hypertension. SUMMARY Hypertension is associated with subclinical cardiovascular disease in children with CKD. Early diagnosis of hypertension by ABPM and identification of subclinical cardiovascular changes provide a window for intervention, which may reverse early cardiovascular disease, thereby delaying dialysis and improving cardiovascular morbidity and mortality.
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Abstract
Atherosclerotic cardiovascular disease is a leading cause of death and disability worldwide, and the atherosclerotic process begins in childhood. Prevention or containment of risk factors that accelerate atherosclerosis can delay the development of atherosclerotic cardiovascular disease. Although current recommendations are to periodically screen for commonly prevailing risk factors for atherosclerosis in children, a single test that could quantify the cumulative effect of all risk factors on the vasculature, thus assessing arterial health, would be helpful in further stratifying risk. Measurement of pulse wave velocity and assessment of augmentation index - measures of arterial stiffness - are easy-to-use, non-invasive methods of examining arterial health. Various studies have assessed pulse wave velocity and augmentation index in children with commonly occurring conditions including obesity, hypertension, insulin resistance, diabetes mellitus, dyslipidaemia, physical inactivity, chronic kidney disease, CHD and acquired heart diseases, and in children who were born premature or small for gestational age. This article summarises pulse wave velocity and augmentation index assessments and the effects of commonly prevailing chronic conditions on arterial health in children. In addition, currently available reference values for pulse wave velocity and augmentation index in healthy children are included. Further research to establish widely applicable normative values and the effect of lifestyle and pharmacological interventions on arterial health in children is needed.
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15
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Stoner L, Weatherall M, Skidmore P, Castro N, Lark S, Faulkner J, Williams MA. Cardiometabolic Risk Variables in Preadolescent Children: A Factor Analysis. J Am Heart Assoc 2017; 6:JAHA.117.007071. [PMID: 29021277 PMCID: PMC5721889 DOI: 10.1161/jaha.117.007071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atherosclerosis begins during preadolescence and is occurring at an accelerated rate. This acceleration has been linked to poor lifestyle behaviors and subsequent cardiometabolic complications. Although the clustering of cardiometabolic risk factors has been recognized for over 2 decades, previous studies in children have predominantly examined the relationships between atherosclerosis and individual cardiometabolic risk factors or have grouped together preadolescent and adolescent children. Further, no known studies have included glycated hemoglobin or central hemodynamic measures such as central systolic blood pressure and augmentation index. METHODS AND RESULTS Principal component analysis was performed on a cross-sectional sample of 392 children (aged 9.5 years, 50% girls) from 3 representative sample sites across New Zealand. Four factors explained 60% of the variance in the measured variables. In order of variance explained, the factors were: blood pressure (central systolic blood pressure and peripheral systolic and diastolic blood pressure), adiposity (waist circumference, body mass index, and glycated hemoglobin), lipids (total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), and vascular (augmentation index, heart rate, and fasting blood glucose). CONCLUSIONS In accordance with previous findings in adults and adolescents, one common factor is unlikely to define cardiometabolic health in preadolescent children. Each of the factors, except vascular, which was predominantly explained by augmentation index, are in agreement with previous findings in adolescents. An additional novel finding was that glycated hemoglobin and fasting blood glucose loaded onto different factors, supporting previous work suggesting that fasting blood glucose indicates short-term glycemic control, whereas glycated hemoglobin reflects chronic glycemic control. CLINICAL TRIAL REGISTRATION URL: www.anzctr.org.au/. ID: ACTRN12614000433606.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, NC
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Paula Skidmore
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Nicholas Castro
- School of Sport and Exercise, Massey University, Wellington, New Zealand
| | - Sally Lark
- School of Sport and Exercise, Massey University, Wellington, New Zealand
| | - James Faulkner
- Department of Sport & Exercise, University of Winchester, United Kingdom
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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16
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Affiliation(s)
- Luminita Voroneanu
- From the Nephrology Department, Dialysis and Renal Transplant Center, “Dr C.I. Parhon” University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- From the Nephrology Department, Dialysis and Renal Transplant Center, “Dr C.I. Parhon” University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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17
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Savant JD, Betoko A, Meyers KEC, Mitsnefes M, Flynn JT, Townsend RR, Greenbaum LA, Dart A, Warady B, Furth SL. Vascular Stiffness in Children With Chronic Kidney Disease. Hypertension 2017; 69:863-869. [PMID: 28373588 DOI: 10.1161/hypertensionaha.116.07653] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/12/2016] [Accepted: 02/08/2017] [Indexed: 12/30/2022]
Abstract
Carotid-femoral pulse wave velocity (cfPWV) is a measure of arterial stiffness associated with cardiovascular events in the general population and in adults with chronic kidney disease. However, few data exist regarding cfPWV in children with chronic kidney disease. We compared observed cfPWV assessed via applanation tonometry in children enrolled in the CKiD cohort study (Chronic Kidney Disease in Children) to normative data in healthy children and examined risk factors associated with elevated cfPWV. cfPWV Z score for height/gender and age/gender was calculated from and compared with published pediatric norms. Multivariable linear regression was used to assess the relationship between cfPWV and age, gender, race, body mass index, diagnosis, urine protein-creatinine ratio, mean arterial pressure, heart rate, number of antihypertensive medications, uric acid, and serum low-density lipoprotein. Of the 95 participants with measured cfPWV, 60% were male, 19% were black, 46% had glomerular cause of chronic kidney disease, 22% had urine protein-creatinine ratio 0.5 to 2.0 mg/mg and 9% had >2.0 mg/mg, mean age was 15.1 years, average mean arterial pressure was 80 mm Hg, and median glomerular filtration rate was 63 mL/min per 1.73 m2 Mean cfPWV was 5.0 m/s (SD, 0.8 m/s); mean cfPWV Z score by height/gender norms was -0.1 (SD, 1.1). cfPWV increased significantly with age, mean arterial pressure, and black race in multivariable analysis; no other variables, including glomerular filtration rate, were independently associated with cfPWV. In this pediatric cohort with mild kidney dysfunction, arterial stiffness was comparable to that of normal children. Future research is needed to examine the impact of chronic kidney disease progression on arterial stiffness and associated cardiovascular parameters in children.
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Affiliation(s)
- Jonathan D Savant
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Aisha Betoko
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Kevin E C Meyers
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Mark Mitsnefes
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Joseph T Flynn
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Raymond R Townsend
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Larry A Greenbaum
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Allison Dart
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Bradley Warady
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Susan L Furth
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.).
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18
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Šuláková T, Feber J, Strnadel J, Pavlíček J, Obermannová B, Petruželková L, Seeman T, Šumník Z. The importance of pulse wave velocity measurement in paediatric population with an increased risk of cardiovascular diseases - Type 1 diabetes and chronic kidney disease. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Sinha MD, Keehn L, Milne L, Sofocleous P, Chowienczyk PJ. Decreased arterial elasticity in children with nondialysis chronic kidney disease is related to blood pressure and not to glomerular filtration rate. Hypertension 2015; 66:809-15. [PMID: 26259592 DOI: 10.1161/hypertensionaha.115.05516] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/16/2015] [Indexed: 12/26/2022]
Abstract
We compared large artery mechanical properties in children with nondialysis stages of chronic kidney disease with those in children with normal renal function, examining the potential effect of blood pressure (BP) components and level of renal dysfunction. Common carotid artery mechanical properties, carotid-femoral pulse wave velocity, and carotid and peripheral BP were measured in children (n=226) with nondialysis chronic kidney disease (n=188; 11.9±3.7 years; 26%, 25%, 30%, 16%, and 3% in stages 1, 2, 3, 4 and 5, respectively) and healthy controls (n=38; 11.5±3.3 years). In children with nondialysis chronic kidney disease when compared with healthy controls, at similar levels of peripheral and carotid BP, carotid artery diastolic diameter and wall thickness were similar. In those with suboptimal BP (≥75th percentile), indices of arterial elasticity indicated greater stiffness than in healthy normotensive controls (distensibility: 92±31 versus 114±33 kPa(-1)×10(-3), P=0.03; compliance: 2.1±0.7 versus 2.6±0.7 m(2) kPa(-1)×10(-6), P=0.02; Young elastic modulus: 0.151±0.068 versus 0.109±0.049 kPa×10(3), P=0.02; and wall stress: 83.6±23.5 versus 68.7±14.9 kPa, P=0.02). In all children, mechanical properties were independently related to carotid and peripheral BP components but not to estimated glomerular filtration rate. In children with nondialysis chronic kidney disease, changes in elastic properties of the carotid artery are primarily related to BP and not to glomerular renal function.
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Affiliation(s)
- Manish D Sinha
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, Kings College London, London, United Kingdom (M.D.S., L.K., L.M., P.J.C.); and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom (M.D.S., P.S.).
| | - Louise Keehn
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, Kings College London, London, United Kingdom (M.D.S., L.K., L.M., P.J.C.); and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom (M.D.S., P.S.)
| | - Laura Milne
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, Kings College London, London, United Kingdom (M.D.S., L.K., L.M., P.J.C.); and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom (M.D.S., P.S.)
| | - Paula Sofocleous
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, Kings College London, London, United Kingdom (M.D.S., L.K., L.M., P.J.C.); and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom (M.D.S., P.S.)
| | - Phil J Chowienczyk
- From the King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, Kings College London, London, United Kingdom (M.D.S., L.K., L.M., P.J.C.); and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom (M.D.S., P.S.)
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20
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 938] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Cabrera Fischer EI, Bia D, Galli C, Valtuille R, Zócalo Y, Wray S, Armentano RL. Hemodialysis decreases carotid-brachial and carotid-femoral pulse wave velocities: A 5-year follow-up study. Hemodial Int 2015; 19:419-28. [PMID: 25645625 DOI: 10.1111/hdi.12269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aortic stiffness is a prognostic parameter associated with patient mortality. Vascular access creation has been shown to have effects on arterial stiffness both in the aorta and in the upper limb arteries in chronically hemodialyzed patients (CHPs). However, no longitudinal studies have been conducted in order to characterize the evolution of arterial stiffness in CHPs. The aims of this work were (a) to measure baseline pulse wave velocity (PWV) in the carotid-femoral and in right and left carotid-brachial pathways in a cohort of CHP and (b) to conduct a 5-year prospective study on the same cohort to determine possible time-related differences. Pulse wave velocity was measured both in the carotid-femoral and in the carotid-brachial pathways, and clinical and biochemical parameters were collected in 25 CHPs, which were followed up after a 5-year lapse. Right and left carotid-brachial pathway PWV values showed significant decreases after the 5-year follow-up, independently of the presence of the vascular access (P < 0.001). Additionally, baseline carotid-brachial PWV was significantly higher (P < 0.001) than values measured 5 years later for upper limbs with vascular access (11.97 ± 2.97 m/sec vs. 6.76 ± 1.48 m/sec, respectively) and without vascular access (12.25 ± 2.38 m/sec vs. 7.18 ± 1.88 m/sec, respectively). Similarly, PWV values in the carotid-femoral pathway decreased significantly (P < 0.001) over the same period (13.27 ± 2.96 m/sec vs. 9.75 ± 2.99 m/sec, respectively). The 5-year follow-up of PWV showed significant decreases in both carotid-brachial and carotid-femoral pathways. The general changes in arterial stiffness could be related to the vascular access creation, hemodialysis therapy, and to the improvement of arterial pressure management.
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Affiliation(s)
- Edmundo I Cabrera Fischer
- Favaloro University, Buenos Aires, Argentina.,National Council of Technical and Scientific Research (CONICET), Buenos Aires, Argentina
| | - Daniel Bia
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay
| | - Cintia Galli
- National Council of Technical and Scientific Research (CONICET), Buenos Aires, Argentina.,Technological National University, Buenos Aires, Argentina
| | | | - Yanina Zócalo
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay
| | - Sandra Wray
- Favaloro University, Buenos Aires, Argentina
| | - Ricardo L Armentano
- Favaloro University, Buenos Aires, Argentina.,Technological National University, Buenos Aires, Argentina
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Rees L, Shroff R. The demise of calcium-based phosphate binders-is this appropriate for children? Pediatr Nephrol 2015; 30:2061-71. [PMID: 25543193 PMCID: PMC4623082 DOI: 10.1007/s00467-014-3017-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/06/2014] [Accepted: 11/12/2014] [Indexed: 01/16/2023]
Abstract
In children with chronic kidney disease (CKD) optimal control of mineral and bone disorder (MBD) is essential not only for the prevention of debilitating skeletal complications and for achieving adequate growth, but also for preserving long-term cardiovascular health. The growing skeleton is particularly vulnerable to the effects of CKD, and bone pain, fractures and deformities are common in children on dialysis. Defective bone mineralisation has been linked with ectopic calcification, which in turn leads to significant morbidity and mortality. Despite national and international guidelines for the management of CKD-MBD, the management of mineral dysregulation in CKD can be extremely challenging, and a significant proportion of patients have calcium, phosphate or parathyroid hormone levels outside the normal ranges. Clinical and experimental studies have shown that, in the setting of CKD, low serum calcium levels are associated with poor bone mineralisation, whereas high serum calcium levels can lead to arterial calcification, even in children. The role of calcium in CKD-MBD is the focus of this review.
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Affiliation(s)
- Lesley Rees
- Paediatric Nephrology, Great Ormond Street Hospital for Children, Great Ormond St, London, WC1N 3JH, UK.
| | - Rukshana Shroff
- Paediatric Nephrology, Great Ormond Street Hospital for Children, Great Ormond St, London, WC1N 3JH, UK
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Abdel-Salam M, EL Wakeel AA, Ibrahim S, Abdel-Rahman T, Ezzat H, Sabour R. Evaluation of Angiopoietin-2 Serum Level as a Marker of Cardiovascular Risk in Children with Chronic Kidney Disease. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojneph.2015.54016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Lowenthal A, Evans JMA, Punn R, Nourse SE, Vu CN, Popat RA, Selamet Tierney ES. Arterial applanation tonometry: feasibility and reproducibility in children and adolescents. Am J Hypertens 2014; 27:1218-24. [PMID: 24627445 DOI: 10.1093/ajh/hpu034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Aortic pulse wave velocity (PWV) and augmentation index (AIx) are markers of vascular health and have recently been used in pediatric clinical trials. However, there are limited data on standardization of these measurements in pediatrics. The objective of this study was to prospectively test the feasibility and reproducibility of PWV and AIx in children and adolescents. METHODS We performed arterial tonometry on 2 different days within 2 weeks in 40 healthy subjects aged 10-19 years. PWV and AIx were measured in triplicate on each visit. RESULTS The visits were separated by a mean of 3.08±3.7 days. We obtained PWV in 77 of 80 (96%) visits and AIx in 76 of 80 (95%) visits in triplicate. Intraclass correlation coefficients (ICCs) for PWV were 0.61 (95% confidence interval (CI) = 0-0.86) when at least 2 measurements and 0.92 (95% CI = 0-1) when 3 measurements were obtained at each visit that met the quality criteria established for adults by the manufacturer (n = 17 and 3 paired visits, respectively). For AIx, ICCs were 0.78 (95% CI = 0.58-0.88) and 0.81 (95% CI = 0.63-0.90) when measurements with an operator index ≥80, a measure of the quality of the waveform, were included (n = 39 and 36 paired visits, respectively). CONCLUSIONS Arterial applanation tonometry is feasible and reproducible in healthy children and adolescents. AIx has excellent intervisit reproducibility, whereas the intervisit reproducibility of PWV relies on acquisition of multiple measurements that meet quality criteria established for adults. These results have implications for the methodology of future pediatric clinical trials in a population at increasingly higher risk for premature atherosclerosis.
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Affiliation(s)
- Alexander Lowenthal
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | - Jasmine M A Evans
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | - Rajesh Punn
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | - Susan E Nourse
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | - Chau N Vu
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | - Rita A Popat
- Division of Epidemiology, Stanford University, Palo Alto, California
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California;
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Stoner L, Lambrick DM, Westrupp N, Young J, Faulkner J. Validation of oscillometric pulse wave analysis measurements in children. Am J Hypertens 2014; 27:865-72. [PMID: 24390294 DOI: 10.1093/ajh/hpt243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pulse wave analysis (PWA) has emerged as a noninvasive, valid, reliable, and widely used technique to investigate central blood pressures and systemic arterial wave reflection (augmentation index). The gold-standard technique is tonometry, but this technique can be challenging, especially when used on children. The purpose of this study was to validate oscillometric PWA for use in children. METHODS Fifty-seven healthy children were recruited for participation. Central blood pressures and peripheral augmentation index (pAIx) were measured objectively using oscillometric (Pulsecor R7) and tonometric (SphygmaCor) devices. All measurements were made during the same visit under standardized conditions between the hours of 8 am and 10 am in the fasted state. RESULTS Tonometric measurements were unsuccessful on 1 child. Comparisons were made on 56 children (mean age = 9.8±1.0 y; 57% male). A very strong relationship was found between devices for central systolic (r = 0.94; P < 0.001), diastolic (r = 0.99; P < 0.001) and mean (r = 0.96; P < 0.001) blood pressures. However, Bland-Altman analysis indicated a bias toward greater systolic blood pressures with the oscillometric monitor (mean difference = 4.5mm Hg; 95% confidence interval (CI) = -5.16 to -3.89). A good relationship was found for pAIx (r = 0.71; P < 0.001); the mean difference between devices was -1.70% (95% CI = -4.47% to 1.08%), which is not significantly different from zero. CONCLUSIONS Findings from this study suggest that oscillometric PWA provides valid measures of central blood pressure and arterial wave reflection in children aged 8-10 years.
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Affiliation(s)
- Lee Stoner
- School of Sport and Exercise, Massey University, Wellington, New Zealand
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26
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Valcheva P, Cardus A, Panizo S, Parisi E, Bozic M, Lopez Novoa JM, Dusso A, Fernández E, Valdivielso JM. Lack of vitamin D receptor causes stress-induced premature senescence in vascular smooth muscle cells through enhanced local angiotensin-II signals. Atherosclerosis 2014; 235:247-55. [PMID: 24880896 DOI: 10.1016/j.atherosclerosis.2014.05.911] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/09/2014] [Accepted: 05/01/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The inhibition of the renal renin-angiotensin system by the active form of vitamin D contributes to the cardiovascular health benefits of a normal vitamin D status. Local production of angiotensin-II in the vascular wall is a potent mediator of oxidative stress, prompting premature senescence. Herein, our objective was to examine the impact of defective vitamin D signalling on local angiotensin-II levels and arterial health. METHODS Primary cultures of aortic vascular smooth muscle cells (VSMC) from wild-type and vitamin D receptor-knockout (VDRKO) mice were used for the assessment of cell growth, angiotensin-II and superoxide anion production and expression levels of cathepsin D, angiotensin-II type 1 receptor and p57(Kip2). The in vitro findings were confirmed histologically in aortas from wild-type and VDRKO mice. RESULTS VSMC from VDRKO mice produced more angiotensin-II in culture, and elicited higher levels of cathepsin D, an enzyme with renin-like activity, and angiotensin-II type 1 receptor, than wild-type mice. Accordingly, VDRKO VSMC showed higher intracellular superoxide anion production, which could be suppressed by cathepsin D, angiotensin-II type 1 receptor or NADPH oxidase antagonists. VDRKO cells presented higher levels of p57(Kip2), impaired proliferation and premature senescence, all of them blunted upon inhibition of angiotensin-II signalling. In vivo studies confirmed higher levels of cathepsin D, angiotensin-II type 1 receptor and p57(Kip2) in aortas from VDRKO mice. CONCLUSION The beneficial effects of active vitamin D in vascular health could be a result of the attenuation of local production of angiotensin-II and downstream free radicals, thus preventing the premature senescence of VSMC.
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Affiliation(s)
- Petya Valcheva
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Anna Cardus
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Sara Panizo
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Eva Parisi
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Milica Bozic
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Jose M Lopez Novoa
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
| | - Adriana Dusso
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
| | - Elvira Fernández
- Nephrology Service and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Jose M Valdivielso
- Experimental Nephrology Laboratory, Department of Experimental Medicine, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain.
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Savant JD, Furth SL, Meyers KE. Arterial Stiffness in Children: Pediatric Measurement and Considerations. Pulse (Basel) 2014; 2:69-80. [PMID: 26587447 PMCID: PMC4646130 DOI: 10.1159/000374095] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arterial stiffness is a natural consequence of aging, accelerated in certain chronic conditions, and predictive of cardiovascular events in adults. Emerging research suggests the importance of arterial stiffness in pediatric populations. METHODS There are different indices of arterial stiffness. The present manuscript focuses on carotid-femoral pulse wave velocity and pulse wave analysis, although other methodologies are discussed. Also reviewed are specific measurement considerations for pediatric populations and the literature describing arterial stiffness in children with certain chronic conditions (primary hypertension, obesity, diabetes, chronic kidney disease, hypercholesterolemia, genetic syndromes involving vasculopathy, and solid organ transplant recipients). CONCLUSIONS The measurement of arterial stiffness in children is feasible and, under controlled conditions, can give accurate information about the underlying state of the arteries. This potentially adds valuable information about the functionality of the cardiovascular system in children with a variety of chronic diseases well beyond that of the brachial artery blood pressure.
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Affiliation(s)
- Jonathan D. Savant
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
| | - Susan L. Furth
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
- Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa., USA
| | - Kevin E.C. Meyers
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
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Kozel BA, Danback JR, Waxler JL, Knutsen RH, de Las Fuentes L, Reusz GS, Kis E, Bhatt AB, Pober BR. Williams syndrome predisposes to vascular stiffness modified by antihypertensive use and copy number changes in NCF1. Hypertension 2013; 63:74-9. [PMID: 24126171 DOI: 10.1161/hypertensionaha.113.02087] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Williams syndrome is caused by the deletion of 26 to 28 genes, including elastin, on human chromosome 7. Elastin insufficiency leads to the cardiovascular hallmarks of this condition, namely focal stenosis and hypertension. Extrapolation from the Eln(+/-) mouse suggests that affected people may also have stiff vasculature, a risk factor for stroke, myocardial infarction, and cardiac death. NCF1, one of the variably deleted Williams genes, is a component of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex and is involved in the generation of oxidative stress, making it an interesting candidate modifier for vascular stiffness. Using a case-control design, vascular stiffness was evaluated by pulse wave velocity in 77 Williams cases and matched controls. Cases had stiffer conducting vessels than controls (P<0.001), with increased stiffness observed in even the youngest children with Williams syndrome. Pulse wave velocity increased with age at comparable rates in cases and controls, and although the degree of vascular stiffness varied, it was seen in both hypertensive and normotensive Williams participants. Use of antihypertensive medication and extension of the Williams deletion to include NCF1 were associated with protection from vascular stiffness. These findings demonstrate that vascular stiffness is a primary vascular phenotype in Williams syndrome and that treatment with antihypertensives or agents inhibiting oxidative stress may be important in managing patients with this condition, potentially even those who are not overtly hypertensive.
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Affiliation(s)
- Beth A Kozel
- Washington University School of Medicine, 660 S Euclid, Campus Box 8208, St. Louis, MO 63110.
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rHuEPO hyporesponsiveness and related high dosages are associated with hyperviscosity in maintenance hemodialysis patients. ScientificWorldJournal 2013; 2013:792698. [PMID: 24198729 PMCID: PMC3806397 DOI: 10.1155/2013/792698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/18/2013] [Indexed: 12/01/2022] Open
Abstract
Objective. Increased viscosity may increase the risk of thrombosis or thromboembolic events. Recombinant human erythropoietin (rHuEPO) is the key stone treatment in anemic ESRD patients with the thrombotic limiting side effect. We evaluated the influence of clinical and laboratory findings on plasma viscosity in MHD patients in the present study. Method. After applying exclusion criteria 84 eligible MHD patients were included (30 female, age: 54.7 ± 13.7 years). Results. Patients with high viscosity had longer MHD history, calcium × phosphorus product, and higher rHuEPO requirement (356.4 versus 204.2 U/kg/week, P: 0.006). rHuEPO hyporesponsiveness was also more common in hyperviscosity group. According to HD duration, no rHuEPO group had the longest and the low rHuEPO dosage group had the shortest duration. Despite similar Hb levels, 68% of patients in high rHuEPO dosage group; and 38.7% of patients in low rHuEPO dosage group had higher plasma viscosity (P: 0.001). Patients with hyperviscosity had higher rHuEPO/Hb levels (P: 0.021). Binary logistic regression analyses revealed that rHuEPO hyporesponsiveness was the major determinant of hyperviscosity. Conclusion. We suggest that the hyperviscous state of the hemodialysis patients may arise from the inflammatory situation of long term HD, the calcium-phosphorus mineral abnormalities, rHuEPO hyporesponsiveness, and related high dosage requirements.
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Alghamdi M, De Souza AM, White CT, Potts MT, Warady BA, Furth SL, Kimball TR, Potts JE, Sandor GGS. Echo-Doppler assessment of the biophysical properties of the aorta in children with chronic kidney disease. Pediatr Cardiol 2013; 34:1218-25. [PMID: 23381174 DOI: 10.1007/s00246-013-0632-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/02/2013] [Indexed: 01/21/2023]
Abstract
Chronic kidney disease (CKD) is known to cause increased arterial stiffness, which is an important independent risk factor for adverse cardiovascular events. The purpose of this study was to assess the vascular properties of the aorta (AO) in a group of children with CKD using a noninvasive echocardiography (echo)-Doppler method. We studied 24 children with stages 2 through 5 CKD and 48 age-matched controls. Detailed echocardiographic assessment and echo-Doppler pulse wave velocity (PWV) was performed. Indices of arterial stiffness, including characteristic (Zc) and input (Zi) impedances, elastic pressure-strain modulus (Ep), and arterial wall stiffness index, were calculated. CKD patients underwent full nephrology assessment, and an iohexol glomerular filtration rate was performed, which allowed for accurate assignment of the CKD stage. CKD patients had greater median systolic blood pressure (114 vs. 110 mmHg; p < 0.04) and pulse pressure (51 vs. 40 mmHg; p < 0.001) compared with controls. PWV was similar between groups (358 vs. 344 cm s(-1); p = 0.759), whereas Zi (182 vs. 131 dyne s cm(-5); p < 0.001), Zc (146 vs. 138 dyne s cm(-5); p = 0.05), and Ep (280 vs. 230 mmHg; p < 0.02) were significantly greater in CKD than in controls. Although load-dependent measures of arterial stiffness were greater in non-dialysis dependent CKD patients, PWV was not increased compared with controls. This suggests that the increased arterial stiffness may not be permanent in these pediatric patients with kidney disease.
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Affiliation(s)
- Mohammed Alghamdi
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
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Shroff R, Dégi A, Kerti A, Kis E, Cseprekál O, Tory K, Szabó AJ, Reusz GS. Cardiovascular risk assessment in children with chronic kidney disease. Pediatr Nephrol 2013; 28:875-84. [PMID: 23070276 DOI: 10.1007/s00467-012-2325-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 01/22/2023]
Abstract
Chronic kidney disease (CKD) is a major factor contributing to cardiovascular (CV) morbidity and mortality with the highest risk in patients on dialysis. An estimation of CV risk is important not only to identify potential modifiable risk factors but also to evaluate the effect of treatments aimed to reduce the risk. Non-invasive methods of measuring vascular changes and circulating biomarkers are available to assess the presence and severity of cardiovascular damage. These include measures of structural (carotid intima-media thickness and coronary artery calcification score) and functional (aortic pulse wave velocity, 24-h ambulatory blood pressure monitoring, ambulatory arterial stiffness index, heart rate variability and flow-mediated dilatation) changes in the vessel wall. In addition, a number of circulating biomarkers of vascular damage and its progression have been studied. Many of these tests are well validated as surrogate markers of future cardiovascular events and death in adult CKD patients, but need technical adaptation, standardization and validation for use in children. With our current state of knowledge, these are best reserved for research studies and scarce clinical resources may be better utilized for preventative strategies to reduce the modifiable risk factors for calcification from early CKD stages.
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Affiliation(s)
- Rukshana Shroff
- Renal Unit, Great Ormond Street Hospital for Children, London, UK
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32
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Kim YS. Is VEGF a new therapeutic target for hypertension in chronic kidney disease? Kidney Res Clin Pract 2013; 32:49-51. [PMID: 26877912 PMCID: PMC4713927 DOI: 10.1016/j.krcp.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/16/2013] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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33
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Shroff R. Phosphate is a vascular toxin. Pediatr Nephrol 2013; 28:583-93. [PMID: 23161206 DOI: 10.1007/s00467-012-2347-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/07/2012] [Accepted: 10/09/2012] [Indexed: 12/18/2022]
Abstract
Elevated phosphate (P) levels are seen in advanced renal failure and, together with dysregulated calcium, parathyroid hormone and vitamin D levels, contribute to the complex of chronic kidney disease-mineral and bone disease (CKD-MBD). Converging evidence from in vitro, clinical and epidemiological studies suggest that increased P is associated with vascular calcification and mortality. When vessels are exposed to high P conditions in vitro, they develop apoptosis, convert to bone-like cells and develop extensive calcification. Clinical studies in children on dialysis show that high P is associated with increased vessel wall thickness, arterial stiffness and coronary calcification. Epidemiological studies in adult dialysis patients demonstrate a significant and independent association between raised P and mortality. Importantly, raised P is associated with cardiovascular changes even in pre-dialysis CKD, and also in subjects with normal renal function but high P. All P binders can effectively reduce serum P, and this decrease is linked to improved survival. Raised serum P triggers the release of fibroblast growth factor 23 (FGF-23), which has the beneficial effect of increasing P excretion in early CKD, but is increased several 1,000-fold in dialysis, and may be an independent cardiovascular risk factor. Both FGF-23 and its co-receptor Klotho may have direct effects on the vasculature leading to calcification. Fascinatingly, disturbances in FGF-23-Klotho and raised P have also been associated with premature aging. These data suggest that high P levels have adverse vascular effects and that maintaining the serum P levels in the normal range reduces cardiovascular risk and mortality.
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Affiliation(s)
- Rukshana Shroff
- Renal Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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Shroff RC, Price KL, Kolatsi-Joannou M, Todd AF, Wells D, Deanfield J, Johnson RJ, Rees L, Woolf AS, Long DA. Circulating angiopoietin-2 is a marker for early cardiovascular disease in children on chronic dialysis. PLoS One 2013; 8:e56273. [PMID: 23409162 PMCID: PMC3568077 DOI: 10.1371/journal.pone.0056273] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/08/2013] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular disease (CVD) is increasingly recognised as a complication of childhood chronic kidney disease (CKD) even in the absence of diabetes and hypertension. We hypothesized that an alteration in angiopoietin-1 and -2, growth factors which regulate endothelial and vascular function could be involved. We report that the endothelial survival factor, angiopoietin-1 is low in children with pre-dialysis CKD whereas the pro-inflammatory angiopoietin-2 is elevated in children on dialysis. In dialysis patients, angiopoietin-2 positively correlated with time on dialysis, systolic blood pressure, and carotid artery intima media thickness. Elevated angiopoietin-2 levels in dialysis versus pre-dialysis CKD patients were also associated with an anti-angiogenic (high soluble VEGFR-1 and low VEGF-A) and pro-inflammatory (high urate, E-selectin, P-selectin and VCAM-1) milieu. Ang-2 was immunodetected in arterial biopsy samples whilst the expression of VEGF-A was significantly downregulated in dialysis patients. Serum urate correlated with angiopoietin-2 levels in dialysis patients and addition of uric acid was able to induce rapid release of angiopoietin-2 from cultured endothelial cells. Thus, angiopoietin-2 is a marker for cardiovascular disease in children on chronic dialysis and may act as an anti-angiogenic and pro-inflammatory effector in this context. The possibility that the release of angiopoietin-2 from endothelia is mediated by urate should be explored further.
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Affiliation(s)
- Rukshana C. Shroff
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Karen L. Price
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Maria Kolatsi-Joannou
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Alexandra F. Todd
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - David Wells
- Department of Chemical Pathology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - John Deanfield
- National Centre for Cardiovascular Disease Prevention and Outcomes, University College London, London, United Kingdom
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Denver, Colorado, United States of America
| | - Lesley Rees
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Adrian S. Woolf
- Institute of Human Development, University of Manchester and the Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - David A. Long
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- * E-mail:
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Valenzuela MP, Almirall J, Amengual MJ. Membrane Bioincompatibility and Ultrafiltration Effects on Pulse Wave Analysis during Haemodialysis. ISRN NEPHROLOGY 2013; 2013:892315. [PMID: 24967232 PMCID: PMC4045438 DOI: 10.5402/2013/892315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 11/26/2012] [Indexed: 11/23/2022]
Abstract
Membrane bioincompatibility was demonstrated by successive white blood cell counts and C3a generation. Pulse wave analysis was obtained by applanation tonometry (SphygmoCor) in a sequential way: basal, after 30 minutes with nul ultrafiltration, and after a complete dialysis with ultrafiltration. At 15 minutes of haemodialysis, significant decrease in leukocyte count occurred: 6801 ± 1186 versus 4412 ± 1333 (P < 0.001), while C3a levels sharply increased from 427 ± 269 to 3501 ± 1638 ng/mL (P < 0.000). No changes were observed in augmentation index without ultrafiltration: 26.1 ± 11.1 versus 26.6 ± 12.4. Only aortic systolic blood pressure was lower at 15 minutes: 120.1 ± 17.7 versus 110.4 ± 25.8 mmHg (P = 0.009), in agreement with a reduction in brachial systolic blood pressure: 135.1 ± 18.1 versus 122.7 ± 27.4 mmHg (P = 0.01), without changes in aortic or brachial diastolic blood pressure. Important changes in pulse wave analysis were observed after a complete haemodialysis session: augmentation index 29.9 ± 10.1 versus 18.6 ± 15.0, aortic systolic blood pressure 139.8 ± 25.5 versus 119.4 ± 28.5 mmHg (P < 0.00), without changes in aortic diastolic blood pressure. In summary, haemodialysis with cellulose diacetate acutely induced a transient state of immunoactivation due to bioincompatibility, this phenomenon was nondetectable by pulse wave analysis. Complete haemodialysis session led to important changes in pulse wave analysis.
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Affiliation(s)
- Maria-Pau Valenzuela
- Nephrology Service, UDIAT, Corporació Parc Taulí and Departament de Medicina, Institut Universitari Parc Taulí (UAB), Parc Taulí S/N, 08208 Sabadell, Spain
| | - Jaume Almirall
- Nephrology Service, UDIAT, Corporació Parc Taulí and Departament de Medicina, Institut Universitari Parc Taulí (UAB), Parc Taulí S/N, 08208 Sabadell, Spain
| | - María-José Amengual
- Laboratory Department, UDIAT, Corporació Parc Taulí and Departament de Medicina, Institut Universitari Parc Taulí (UAB), Parc Taulí S/N, 08208 Sabadell, Spain
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Thang OHD, Serné EH, Grooteman MPC, Smulders YM, Ter Wee PM, Tangelder GJ, Nubé MJ. Premature aging of the microcirculation in patients with advanced chronic kidney disease. NEPHRON EXTRA 2012; 2:283-92. [PMID: 23243413 PMCID: PMC3521446 DOI: 10.1159/000343295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Increasing age and advanced chronic kidney disease (CKD) are both associated with an attenuated vasodilator response of the skin microcirculation. In the present study, we investigated the effect of aging on microvascular reactivity in patients with advanced CKD. Methods Acetylcholine (ACh)-mediated endothelium-dependent vasodilation and sodium nitroprusside (SNP)-mediated endothelium-independent vasodilation were assessed by iontophoresis combined with laser Doppler flowmetry. Microvascular function was compared between 52 patients with advanced CKD (stage 4–5: n = 16; end-stage renal disease: n = 36) and 33 healthy control subjects. As aging has an important effect on microvascular function, both control subjects and CKD patients were divided in subgroups younger and older than 45 years. Linear regression analysis was applied to assess potential associations between microvascular function and various demographic and clinical parameters. Results There were three main findings. (1) In young patients with advanced CKD, both ACh- and SNP-mediated vasodilations were impaired if compared to young healthy controls (p = 0.04 and p = 0.056, respectively). (2) In young patients with advanced CKD, microvascular function was similar to old healthy controls and elderly patients with advanced CKD. (3) Whereas age was inversely associated with microvascular function in healthy controls (log ACh-mediated vasodilation R = −0.41; p = 0.02 and log SNP-mediated vasodilation R = −0.38; p = 0.03), no such relation was found in patients with advanced CKD. Conclusions Our results are consistent with premature aging of the microvascular vasodilatory capacity in patients with advanced CKD.
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Affiliation(s)
- Oanh H D Thang
- Department of Nephrology, Institute for Cardiovascular Research VU Medical Center, Amsterdam, The Netherlands
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Intima media thickness in children undergoing dialysis. Pediatr Nephrol 2012; 27:1557-64. [PMID: 22552884 DOI: 10.1007/s00467-012-2173-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 03/19/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Uremic vasculopathy, including vascular calcification, increases the risk for cardiovascular disease and mortality in chronic kidney disease (CKD) patients. We have investigated the prevalence and factors associated with vasculopathy in children undergoing peritoneal dialysis (PD) or hemodialysis (HD) in a single center. METHODS Common carotid intima media thickness (cIMT) and its relation with demographics, biochemical parameters and medication was analyzed in 60 patients (mean age 12.9 ± 3.4 years; 27 girls) treated with PD (n = 31) or HD (n = 29) for 34 ± 34 months. Patients were divided into two groups: normal cIMT and increased cIMT. RESULTS Mean levels of calcium, phosphate and calcium/phosphate product were in the normal range, the but parathyroid hormone level, 729 ± 670 pg/mL, was higher than the National Kidney Foundation Kidney Disease Outcome Quality Iniative (K/DOQI) recommendations. Twenty-nine patients had increased cIMT, which was associated with time on dialysis of >2 years, hypercalcemia, higher daily dose of calcitriol and HD (vs. PD). In the multivariate analysis, accounting for time on dialysis, HD persisted as a risk for increased cIMT. CONCLUSIONS The prevalence of increased cIMT in children on dialysis is similar to that reported in adults with CKD and increased with time on dialysis. HD was associated with increased cIMT, independently of time on dialysis; however, the results should be interpreted with caution due to the possible impact of confounding factors. These results underline the need to monitor and, if possible, prevent and treat increased cIMT in children on dialysis.
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Dégi A, Kerti A, Kis E, Cseprekál O, Tory K, Szabó AJ, Reusz GS. Cardiovascular risk assessment in children following kidney transplantation. Pediatr Transplant 2012; 16:564-76. [PMID: 22694162 DOI: 10.1111/j.1399-3046.2012.01730.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CV diseases are the leading cause of death among patients with ESRD. RTX decreases the CV risk; however, it still remains definitely higher than that of the general population. Large multicenter and longitudinal studies are difficult to perform and hard end-points of CV events are usually missing among pediatric population. Thus, appropriate estimation of CV risk is of crucial importance to define the potential hazards and to evaluate the effect of treatments aimed to reduce the risk. A number of validated non-invasive methods are available to assess the extent of CV damage in adults, such as calcification scores, cIMT, aPWV, 24-h ABPM, AASI, and HRV; however, they need adaptation, standardization, and validation in pediatric studies. cIMT and PWV are the most promising methods, as pediatric normative values are already present. The up-to-date treatment of ESRD aims not only to save life, but to offer the patient a life expectancy approaching that of the healthy population and to ensure a reasonable quality of life.
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Affiliation(s)
- Arianna Dégi
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
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Briet M, Boutouyrie P, Laurent S, London GM. Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int 2012; 82:388-400. [DOI: 10.1038/ki.2012.131] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tawadrous H, Kamran H, Salciccioli L, Schoeneman MJ, Lazar J. Evaluation of arterial structure and function in pediatric patients with end-stage renal disease on dialysis and after renal transplantation. Pediatr Transplant 2012; 16:480-5. [PMID: 22624620 DOI: 10.1111/j.1399-3046.2012.01721.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CVD is a major cause of morbidity and mortality in pediatric patients with CKD. It is unclear whether vascular abnormalities in these patients are reversible, and if transplantation portends salutary effects on arterial function. We compared FMD, PWV, AI75, and CIMT in 15 dialysis (D), 14 transplant patients (T), and 15 controls (C), and their associations with cardiovascular risk factors. There was stepwise lower FMD (p < 0.001), higher AI75 (p < 0.001), higher PWV (p = 0.01), and higher CIMT SDS for age (p = 0.03) and height (p = 0.006) in the D group than T and C groups. FMD, PWV, and CIMT were unrelated to dialysis duration or time from transplantation. On multivariate analysis, group status was independently associated with FMD (β = 3.15, p = 0.002), AI75 (β = -5.95, p = 0.01), PWV (β = -0.57, p = 0.07) and CIMT (β = -0.02, p = 0.04) and CIMT SDS for height (β = -0.541, p = 0.009). FMD is lower and AI75, PWV and CIMT are higher in pediatric patients maintained on D than T/C. T patients have similar AI75, PWV and CIMT to C although FMD remains reduced. These findings suggest that transplantation stabilizes or improves CKD associated arteriopathy.
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Affiliation(s)
- Hanan Tawadrous
- Department of Pediatrics, Division of Pediatric Nephrology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Vitamin D deficiency and arterial wall stiffness in children with chronic kidney disease. Pediatr Cardiol 2012; 33:122-8. [PMID: 21912948 DOI: 10.1007/s00246-011-0101-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
Abstract
Arterial wall stiffness is a recognized complication in children with chronic kidney disease (CKD). Vascular abnormalities in these patients are shown to predate cardiac abnormalities such as left ventricular hypertrophy and diastolic dysfunction. The etiology of vascular abnormalities in these patients currently is not clear. This study explored the relationship between various parameters of calcium-phosphorus metabolism including 25-hydroxy vitamin D and arterial wall stiffness in pediatric patients with CKD. This study investigated a cohort of 43 children with CKD who had no history of underlying congenital or structural cardiac disease. The Augmentation Index (AI), a measure of peripheral arterial reflective properties using radial artery tonometry, was used as an indirect measure of central aortic stiffness. Serum biochemical markers of calcium-phosphorus metabolism were simultaneously measured. Univariate testing showed that AI correlated with worsening kidney function. Serum 25-hydroxy vitamin D levels were low and correlated negatively with AI (r = -0.39; p < 0.05). Multiple regression analysis showed that 25-hydroxy vitamin D was the only significant independent predictor of increased central arterial stiffness in the subgroup of children receiving hemodialysis. No association was observed between AI and any other measured biochemical parameter of calcium-phosphorus metabolism. This is the first study to investigate pediatric patients with CKD that suggests an association between nutritional vitamin D deficiency and increased arterial stiffness in children with CKD. The pathophysiologic mechanisms of vitamin D that regulate increased arterial stiffness need to be integrated further in pediatric CKD patients.
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Central blood pressures are associated with left ventricular mass index among African-American adolescents. Am J Hypertens 2012; 25:41-5. [PMID: 21976275 DOI: 10.1038/ajh.2011.174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is a high burden of premature cardiovascular disease (CVD) among African Americans. Measures of central aortic blood pressure (CASP) and wave reflection are predictive of CVD risk in adults, but there is a paucity of data regarding the relation of these measures to target organ damage among adolescents. The objective of this study was to examine the relationship between CASP, central pulse pressure (CPP), and augmentation index (AI) with left ventricular mass index (LVMI). METHODS A cohort of 120 African-American adolescents was examined. Study participants underwent measurement of peripheral blood pressure (BP) using auscultation, pulse wave analysis (PWA) for determination of CASP, CPP, and AI, and echocardiography for determination of LVMI. RESULTS The cohort was 55% male, with mean BP 114/62 mm Hg, mean LVMI 36 g/m(2.7), mean CASP 94 mm Hg, mean CPP 31 mmHg, and mean AI was 0.5%. After adjustment for potential confounders, peripheral systolic BP (SBP) was significantly associated with LVMI (P = 0.008), but diastolic pressure was not (P = 0.887). The CASP and CPP were significantly associated with LVMI (P = 0.020 and 0.005, respectively). Peripheral SBP, CASP, and CPP had similar associations with respect to LVMI (r(2) = 0.26, 0. 26, and 0.27, respectively). CONCLUSION Central BP is associated with LVMI among African-American adolescents, and these associations are similar to those seen with peripheral BP measurements.
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Shroff R, Quinlan C, Mitsnefes M. Uraemic vasculopathy in children with chronic kidney disease: prevention or damage limitation? Pediatr Nephrol 2011; 26:853-65. [PMID: 21080003 DOI: 10.1007/s00467-010-1691-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 01/21/2023]
Abstract
Since the inception of pediatric dialysis programmes nearly 50 years ago, there have been vast improvements in both the technology and expertise in the care of children with chronic kidney disease (CKD). Nevertheless, children on dialysis continue to have a significantly higher mortality than their healthy peers and cardiovascular disease (CVD) is the most common cause of death in this group. Chronic kidney disease is described as the "perfect storm" of risk factors for CVD development, and vascular calcification is a highly regulated cell-mediated process with several promoters and inhibitors of calcification. CVD begins early in the course of CKD and there is an independent and graded association between cardiovascular morbidity and renal decline. Also, it is shown that once vascular damage and calcification begin, they progress inexorably in the uraemic milieu and may only be partially reversed after successful transplantation. Thus, preventing the development of CVD is key, and early identification and management of specific CVD-related risk factors should begin from the early stages of CKD. While the vasculopathy of childhood CKD is clearly multifactorial, clinical, epidemiological and cell biology studies provide converging evidence pointing to the role of dysregulated mineral metabolism as an important modifiable risk factor in the development of vascular calcification. In this review we focus on the role of calcium, phosphate, parathyroid hormone and vitamin D in ectopic vascular calcification, and discuss the role of screening, early intervention and management of established vascular calcification.
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Affiliation(s)
- Rukshana Shroff
- Department of Nephrourology, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom.
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Dysregulated mineral metabolism in children with chronic kidney disease. Curr Opin Nephrol Hypertens 2011; 20:233-40. [DOI: 10.1097/mnh.0b013e3283455e8c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Doyon A, Schaefer F. Taking the pulse of a sick kidney: arterial stiffness in glomerulonephritis. Pediatr Nephrol 2011; 26:161-3. [PMID: 21153556 DOI: 10.1007/s00467-010-1730-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 11/13/2010] [Accepted: 11/16/2010] [Indexed: 01/11/2023]
Abstract
Arterial stiffness is an increasingly recognized independent predictor of cardiovascular morbidity. Vessel volume and wall texture are the main determinants of pulse wave velocity (PWV), the most commonly used indicator of arterial elasticity. Hence, measurements of PWV will be affected by the site of measurement and the overall dimensions of the vascular tree as well as by alterations of vascular morphology. In children, methodological heterogeneity and the lack of pediatric reference values complicate the interpretation of PWV. Arterial elasticity is altered in numerous clinical conditions such as vasculitis, end-stage renal disease, and diabetes. Novel evidence suggests that acute postinfectious glomerulonephritis, but not pyelonephritis, is also associated with increased arterial stiffness, the persistence of which may predict the emergence of chronic kidney disease. We review the potential mechanisms underlying the link between acute and chronic kidney disease and impaired arterial elasticity. These might include activation of the renin-angiotensin system, sympathetic hyperactivation, and a subclinical state of inflammation. In view of the excessive cardiovascular comorbidity associated with kidney disease, the increasing evidence of the prognostic relevance of arterial stiffness should encourage further research investigating the usefulness of PWV as a biomarker in acute and chronic kidney disorders.
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Affiliation(s)
- Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
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Saland JM, Pierce CB, Mitsnefes MM, Flynn JT, Goebel J, Kupferman JC, Warady BA, Furth SL. Dyslipidemia in children with chronic kidney disease. Kidney Int 2010; 78:1154-63. [PMID: 20736985 DOI: 10.1038/ki.2010.311] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Dyslipidemia, a known risk factor for atherosclerosis, is frequent among both adults and children with chronic kidney disease. Here, we describe the prevalence and pattern of dyslipidemia from a cross-sectional analysis of 391 children aged 1-16 years, enrolled in the multicenter Chronic Kidney Disease in Children (CKiD) study, with a median glomerular filtration rate (GFR), measured by the plasma disappearance of iohexol, of 43 ml/min per 1.73 m2. Multivariate analysis was applied to adjust for age, gender, body mass index (BMI), GFR, and the urinary protein/creatinine ratio. Proteinuria was in the nephrotic range in 44 and the BMI exceeded the 95th percentile in 57 patients of this cohort. Baseline lipid analysis found a high prevalence of hypertriglyceridemia in 126, increased non-HDL-C in 62, and reduced HDL-C in 83. Overall, 177 children had dyslipidemia, of whom 79 had combined dyslipidemia. Lower GFR was associated with higher triglycerides, lower HDL-C, and higher non-HDL-C. Nephrotic-range proteinuria was significantly associated with dyslipidemia and combined dyslipidemia. Compared with children with a GFR>50, children with a GFR<30 had significantly increased odds ratios for any dyslipidemia or for combined dyslipidemia. Hence, among children with moderate chronic kidney disease, dyslipidemia is common and is associated with lower GFR, nephrotic proteinuria, and non-renal factors including age and obesity.
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Affiliation(s)
- Jeffrey M Saland
- Department of Pediatrics, The Mount Sinai School of Medicine, New York, New York 10029, USA.
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Reusz GS, Cseprekal O, Temmar M, Kis E, Cherif AB, Thaleb A, Fekete A, Szabó AJ, Benetos A, Salvi P. Reference Values of Pulse Wave Velocity in Healthy Children and Teenagers. Hypertension 2010; 56:217-24. [PMID: 20566959 DOI: 10.1161/hypertensionaha.110.152686] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Carotid-femoral pulse wave velocity is an established method for characterizing aortic stiffness, an individual predictor of cardiovascular mortality in adults. Normal pulse wave velocity values for the pediatric population derived from a large data collection have yet to be available. The aim of this study was to create a reference database and to characterize the factors determining pulse wave velocity in children and teenagers. Carotid-femoral pulse wave velocity was measured by applanation tonometry. Reference tables from pulse wave velocities obtained in 1008 healthy subjects (aged between 6 and 20 years; 495 males) were generated using a maximum-likelihood curve-fitting technique for calculating SD scores in accordance with the skewed distribution of the raw data. Effects of sex, age, height, weight, blood pressure, and heart rate on pulse wave velocity were assessed. Sex-specific reference tables and curves for age and height are presented. Pulse wave velocity correlated positively (
P
<0.001) with age, height, weight, and blood pressure while correlating negatively with heart rate. After multiple regression analysis, age, height, and blood pressure remained major predictors of pulse wave velocity. This study, involving >1000 children, is the first to provide reference values for pulse wave velocity in children and teenagers, thereby constituting a suitable tool for longitudinal clinical studies assessing subgroups of children who are at long-term risk of cardiovascular disease.
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Affiliation(s)
- George S. Reusz
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Orsolya Cseprekal
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Mohamed Temmar
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Éva Kis
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Abdelghani Bachir Cherif
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Abddelhalim Thaleb
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Andrea Fekete
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Attila J. Szabó
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Athanase Benetos
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
| | - Paolo Salvi
- From the First Department of Pediatrics (G.S.R., O.C., E.K., A.F., A.J.S.), Semmelweis University, Budapest, Hungary; Telomere Cardiology Centre (M.T.), Ghardaia, Algeria; Department of Internal Medicine (A.B.C., A.T.), University of Blida, Blida, Algeria; Department of Internal Medicine and Geriatrics (A.B., P.S.), Institut National de la Santé et de la Recherche Médicale U961, University of Nancy, Nancy, France; Department of Internal Medicine (P.S.), University of Bologna, Bologna, Italy
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Sozeri B, Mir S, Kara OD, Levent E. When does the cardiovascular disease appear in patients with chronic kidney disease? Pediatr Cardiol 2010; 31:821-8. [PMID: 20401476 DOI: 10.1007/s00246-010-9710-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease is a leading cause of long-term morbidity and mortality among children with chronic kidney disease (CKD). At which stage of CKD these appear in children is unknown. This study aimed to determine the prevalence of cardiovascular disease in pediatric CKD patients and to explore the relationship of these changes and treatment methods. The study enrolled pediatric patients with stages 1-5 CKD including 20 patients receiving predialysis (PreD), 8 receiving peritoneal dialysis, and 14 receiving hemodialysis. Aortic stiffness, defined as decreased aortic strain (S) and increased pressure strain normalized by diastolic pressure (Ep*), was described. Sonography of the common carotid artery and left ventricle was performed. The mean age of the children was 13.3 + or - 5.3 years. The patients had lower S values (0.35 + or - 0.23) than the control subjects (0.44 + or - 0.2) (P < 0.05) but higher Ep* (2.46 + or - 1.31 vs. 1.32 + or - 0.09; P < 0.05). Aortic stiffness was found in 13 patients. The PreD group had lower As levels than the dialysis group but higher levels than the control group. The patients (n = 32) had greater carotid intima-media thickness than the control subjects (0.58 + or - 0.14 vs. 0.35 + or - 0.12; P < 0.05). The intima-media thickness was greatest in the PreD group (P < 0.05). The patients had a higher left ventricular mass index (LVMI; 42.4 + or - 15.6) than the control subjects (28.8 + or - 8.47) (P < 0.05) and a larger left ventricle end diastolic diameter (LVEDD; 3.44 + or - 0.76 vs. 2.59 + or - 0.34; P < 0.05). Left ventricular hypertrophy was found in 32 patients. Both LVMI and LVEDD were higher in the groups receiving hemodialysis and lower in the PreD group. Increased carotid-intima media thickness and left ventricle hypertrophy appeared without hypertension in the PreD group. The indications and timing of dialysis should be reevaluated for children with CKD. In the dialysis groups, fewer cardiovascular changes were found with peritoneal dialysis than with hemodialysis. Therefore, peritoneal dialysis should be preferable to hemodialysis for children with CKD.
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Affiliation(s)
- Betul Sozeri
- Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey.
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