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Hamdani G, Urbina EM, Daniels SR, Falkner BE, Ferguson MA, Flynn JT, Hanevold CD, Ingelfinger JR, Khoury PR, Lande MB, Meyers KE, Samuels J, Mitsnefes M. Ambulatory Blood Pressure and Number of Subclinical Target Organ Injury Markers in Youth: The SHIP AHOY Study. medRxiv 2024:2024.03.15.24304137. [PMID: 38562855 PMCID: PMC10984045 DOI: 10.1101/2024.03.15.24304137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents. Methods 244 participants (mean age 15.5±1.8 years, 60.1% male) were studied. Participants were divided based on both systolic clinic and ambulatory BP (ABP), into low- (<75 th percentile), mid- (75 th -90 th percentile) and high-risk (>90 th percentile) groups. TOI assessments included left ventricular mass, systolic and diastolic function, and vascular stiffness. The number of TOI markers for each participant was calculated. A multivariable general linear model was constructed to evaluate the association of different participant characteristics with higher numbers of TOI markers. Results 47.5% of participants had at least one TOI marker: 31.2% had one, 11.9% two, 3.7% three, and 0.8% four. The number of TOI markers increased according to the BP risk groups: the percentage of participants with more than one TOI in the low-, mid-, and high groups based on clinic BP was 6.7%, 19.1%, and 21.8% (p=0.02), and based on ABP was 9.6%, 15.8%, and 32.2% (p<0.001). In a multivariable regression analysis, both clinic BP percentile and ambulatory SBP index were independently associated with the number of TOI markers. When both clinic and ABP were included in the model, only the ambulatory SBP index was significantly associated with the number of markers. Conclusion High SBP, especially when assessed by ABPM, was associated with an increasing number of subclinical cardiovascular injury markers in adolescents.
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Xiao N, Starr M, Stolfi A, Hamdani G, Hashmat S, Kiessling SG, Sethna C, Kallash M, Matloff R, Woroniecki R, Sanderson K, Yamaguchi I, Cha SD, Semanik MG, Chanchlani R, Flynn JT, Mitsnefes M. Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study. J Pediatr 2024; 264:113765. [PMID: 37778410 PMCID: PMC10980536 DOI: 10.1016/j.jpeds.2023.113765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To describe the blood pressure outcomes of infants admitted to the neonatal intensive care unit (NICU) with idiopathic (nonsecondary) hypertension (HTN) who were discharged on antihypertensive therapy. STUDY DESIGN Retrospective, multicenter study of 14 centers within the Pediatric Nephrology Research Consortium. We included all infants with a diagnosis of idiopathic HTN discharged from the NICU on antihypertensive treatment. The primary outcome was time to discontinuation of antihypertensive therapy, grouped into (≤6 months, >6 months to 1 year, and >1 year). Comparisons between groups were made with χ2 tests, Fisher's exact tests, and ANOVA. RESULTS Data from 118 infants (66% male) were included. Calcium channel blockers were the most prescribed class of antihypertensives (56%) in the cohort. The percentages remaining on antihypertensives after NICU discharge were 60% at 6 months, 26% at 1 year, and 7% at 2 years. Antenatal steroid treatment was associated with decreased likelihood of antihypertensive therapy >1 year after discharge. CONCLUSIONS This multicenter study reports that most infants admitted to the NICU diagnosed with idiopathic HTN will discontinue antihypertensive treatment by 2 years after NICU discharge. These data provide important insights into the outcome of neonatal HTN, but should be confirmed prospectively.
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Affiliation(s)
- Nianzhou Xiao
- Department of Nephrology, Valley Children's Healthcare, Madera, CA.
| | - Michelle Starr
- Riley Hospital for Children and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Adrienne Stolfi
- Department of Pediatrics, Wright State University, Dayton, OH
| | - Gilad Hamdani
- Nephrology and Hypertension Institute, Schneider's Children Medical Center, Petah Tikva, Israel
| | - Shireen Hashmat
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Stefan G Kiessling
- Division of Pediatric Nephrology, Kentucky Children's Hospital, University of Kentucky, Lexington, KY
| | - Christina Sethna
- Division of Pediatric Nephrology, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, Queens, NY
| | - Mahmoud Kallash
- Division of Nephrology, Nationwide Children's Hospital, Columbus, OH
| | - Robyn Matloff
- Division of Pediatric Nephrology, Connecticut Children's Hospital, University of Connecticut School of Medicine, Hartford, CT
| | - Robert Woroniecki
- Division of Pediatric Nephrology and Hypertension, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Keia Sanderson
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC
| | - Ikuyo Yamaguchi
- Division of Nephrology and Hypertension, Department of Pediatrics, Oklahoma Children's Hospital at University of Oklahoma Health Sciences Center, Oklahoma, OK
| | - Stephen D Cha
- Division of Nephrology, Akron Children's Hospital, Akron, OH
| | - Michael G Semanik
- Division of Nephrology, Department of Pediatrics, University of Wisconsin at Madison, Madison, WI
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Medical Center, Cincinnati, OH
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Kusumi K, Raina R, Samuels J, Tibrewal A, Furth S, Mitsnefes M, Devineni S, Warady BA. Evidence of increased vascular stiffness and left ventricular hypertrophy in children with cystic kidney disease. Pediatr Nephrol 2023; 38:4093-4100. [PMID: 37428222 DOI: 10.1007/s00467-023-06081-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the most common cause of mortality in chronic kidney disease (CKD). Children with early-onset CKD arguably experience the greatest lifetime CVD burden. We utilized data from the Chronic Kidney Disease in Children Cohort Study (CKiD) to evaluate two pediatric CKD cohorts: congenital anomalies of the kidney and urinary tract (CAKUT) and cystic kidney disease for CVD risks and outcomes. METHODS CVD risk factors and outcomes including blood pressures, left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and ambulatory arterial stiffness index (AASI) scores were evaluated. RESULTS Forty-one patients in the cystic kidney disease group were compared to 294 patients in the CAKUT group. Cystic kidney disease patients had higher cystatin-C levels, despite similar iGFR. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) indexes were higher in the CAKUT group, but a significantly higher proportion of cystic kidney disease patients was on anti-hypertensive medications. Cystic kidney disease patients had increased AASI scores and a higher incidence of LVH. CONCLUSIONS This study provides a nuanced analysis of CVD risk factors and outcomes including AASI and LVH in two pediatric CKD cohorts. Cystic kidney disease patients had increased AASI scores, higher incidence of LVH, and higher rates of anti-hypertensive medication use which could imply a greater burden of CVD despite similar GFR. Our work suggests that additional mechanisms may contribute to vascular dysfunction in cystic kidney disease, and that these patients may need additional interventions to prevent the development of CVD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Kirsten Kusumi
- Division of Nephrology, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Rupesh Raina
- Division of Nephrology, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA.
- Northeast Ohio Medical University, Rootstown, OH, USA.
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, USA.
| | - Joshua Samuels
- Division of Pediatric Nephrology and Hypertension, University of Texas Medical School at Houston, Houston, TX, USA
| | - Abhishek Tibrewal
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, USA
| | - Susan Furth
- Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | - Mark Mitsnefes
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Bradley A Warady
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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Denburg MR, Razzaghi H, Goodwin Davies AJ, Dharnidharka V, Dixon BP, Flynn JT, Glenn D, Gluck CA, Harshman L, Jovanovska A, Katsoufis CP, Kratchman AL, Levondosky M, Levondosky R, McDonald J, Mitsnefes M, Modi ZJ, Musante J, Neu AM, Pan CG, Patel HP, Patterson LT, Schuchard J, Verghese PS, Wilson AC, Wong C, Forrest CB. The Preserving Kidney Function in Children With CKD (PRESERVE) Study: Rationale, Design, and Methods. Kidney Med 2023; 5:100722. [PMID: 37965485 PMCID: PMC10641283 DOI: 10.1016/j.xkme.2023.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Rationale & Objective PRESERVE seeks to provide new knowledge to inform shared decision-making regarding blood pressure (BP) management for pediatric chronic kidney disease (CKD). PRESERVE will compare the effectiveness of alternative strategies for monitoring and treating hypertension on preserving kidney function; expand the National Patient-Centered Clinical Research Network (PCORnet) common data model by adding pediatric- and kidney-specific variables and linking electronic health record data to other kidney disease databases; and assess the lived experiences of patients related to BP management. Study Design Multicenter retrospective cohort study (clinical outcomes) and cross-sectional study (patient-reported outcomes [PROs]). Setting & Participants PRESERVE will include approximately 20,000 children between January 2009-December 2022 with mild-moderate CKD from 15 health care institutions that participate in 6 PCORnet Clinical Research Networks (PEDSnet, STAR, GPC, PaTH, CAPRiCORN, and OneFlorida+). The inclusion criteria were ≥1 nephrologist visit and ≥2 estimated glomerular filtration rate (eGFR) values in the range of 30 to <90 mL/min/1.73 m2 separated by ≥90 days without an intervening value ≥90 mL/min/1.73 m2 and no prior dialysis or kidney transplant. Exposures BP measurements (clinic-based and 24-hour ambulatory BP); urine protein; and antihypertensive treatment by therapeutic class. Outcomes The primary outcome is a composite event of a 50% reduction in eGFR, eGFR of <15 mL/min/1.73 m2, long-term dialysis or kidney transplant. Secondary outcomes include change in eGFR, adverse events, and PROs. Analytical Approach Longitudinal models for dichotomous (proportional hazards or accelerated failure time) and continuous (generalized linear mixed models) clinical outcomes; multivariable linear regression for PROs. We will evaluate heterogeneity of treatment effect by CKD etiology and degree of proteinuria and will examine variation in hypertension management and outcomes based on socio-demographics. Limitations Causal inference limited by observational analyses. Conclusions PRESERVE will leverage the PCORnet infrastructure to conduct large-scale observational studies that address BP management knowledge gaps for pediatric CKD, focusing on outcomes that are meaningful to patients. Plain-Language Summary Hypertension is a major modifiable contributor to loss of kidney function in chronic kidney disease (CKD). The purpose of PRESERVE is to provide evidence to inform shared decision-making regarding blood pressure management for children with CKD. PRESERVE is a consortium of 16 health care institutions in PCORnet, the National Patient-Centered Clinical Research Network, and includes electronic health record data for >19,000 children with CKD. PRESERVE will (1) expand the PCORnet infrastructure for research in pediatric CKD by adding kidney-specific variables and linking electronic health record data to other kidney disease databases; (2) compare the effectiveness of alternative strategies for monitoring and treating hypertension on preserving kidney function; and (3) assess the lived experiences of patients and caregivers related to blood pressure management.
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Affiliation(s)
- Michelle R. Denburg
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Vikas Dharnidharka
- St. Louis Children’s Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Bradley P. Dixon
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Joseph T. Flynn
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Dorey Glenn
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Lyndsay Harshman
- University of Iowa Stead Family Children’s Hospital, Iowa City, IA
| | | | | | | | | | | | - Jill McDonald
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Mark Mitsnefes
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Zubin J. Modi
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | - Alicia M. Neu
- Johns Hopkins Children’s Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Cynthia G. Pan
- Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI
| | - Hiren P. Patel
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Priya S. Verghese
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy C. Wilson
- Riley Children’s Health, Indiana University School of Medicine, Indianapolis, IN
| | - Cynthia Wong
- Stanford Children’s Health, Stanford University School of Medicine, Palo Alto, CA
| | - Christopher B. Forrest
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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5
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Stone HK, Mitsnefes M, Dickinson K, Burrows EK, Razzaghi H, Luna IY, Gluck CA, Dixon BP, Dharnidharka VR, Smoyer WE, Somers MJ, Flynn JT, Furth SL, Bailey C, Forrest CB, Denburg M, Nehus E. Clinical course and management of children with IgA vasculitis with nephritis. Pediatr Nephrol 2023; 38:3721-3733. [PMID: 37316676 PMCID: PMC10514113 DOI: 10.1007/s00467-023-06023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND IgA vasculitis is the most common vasculitis in children and is often complicated by acute nephritis (IgAVN). Risk of chronic kidney disease (CKD) among children with IgAVN remains unknown. This study aimed to describe the clinical management and kidney outcomes in a large cohort of children with IgAVN. METHODS This observational cohort study used the PEDSnet database to identify children diagnosed with IgAV between January 1, 2009, and February 29, 2020. Demographic and clinical characteristics were compared among children with and without kidney involvement. For children followed by nephrology, clinical course, and management patterns were described. Patients were divided into four categories based on treatment: observation, renin-angiotensin-aldosterone system (RAAS) blockade, corticosteroids, and other immunosuppression, and outcomes were compared among these groups. RESULTS A total of 6802 children had a diagnosis of IgAV, of whom 1139 (16.7%) were followed by nephrology for at least 2 visits over a median follow-up period of 1.7 years [0.4,4.2]. Conservative management was the most predominant practice pattern, consisting of observation in 57% and RAAS blockade in 6%. Steroid monotherapy was used in 29% and other immunosuppression regimens in 8%. Children receiving immunosuppression had higher rates of proteinuria and hypertension compared to those managed with observation (p < 0.001). At the end of follow-up, 2.6 and 0.5% developed CKD and kidney failure, respectively. CONCLUSIONS Kidney outcomes over a limited follow-up period were favorable in a large cohort of children with IgAV. Immunosuppressive medications were used in those with more severe presentations and may have contributed to improved outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Hillarey K Stone
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kimberley Dickinson
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Evanette K Burrows
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ingrid Y Luna
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Caroline A Gluck
- Division of Pediatric Nephrology, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Bradley P Dixon
- Renal Section, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vikas R Dharnidharka
- Division of Pediatric Nephrology, Washington University School of Medicine, Saint Louis, MO, USA
| | - William E Smoyer
- Center for Clinical and Translational Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael J Somers
- Division of Nephrology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Susan L Furth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Charles Bailey
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Denburg
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Edward Nehus
- Department of Pediatrics, West Virginia University Charleston Campus, Charleston, WV, USA
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Chung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R. Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:2280-2292. [PMID: 37737026 DOI: 10.1161/hypertensionaha.123.20967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.
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Affiliation(s)
- Jason Chung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (J.C.)
| | - Cal Robinson
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada (C.R.)
| | - Lauren Sheffield
- Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada (L.S.)
| | - Prathayini Paramanathan
- All Saints University College of Medicine, Kingstown, Saint Vincent and the Grenadines (P.P.)
| | - Andrew Yu
- Faculty of Science, University of Alberta, Edmonton, Canada (A.Y.)
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada (S.S.)
| | - Mark Mitsnefes
- Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Department of Pediatrics and Medicine, Division of Nephrology, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada (R.S.P.)
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, United Kingdom (M.D.S.)
| | - Myanca Rodrigues
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (M.R.)
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
- University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, Canada (J.D.)
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
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7
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Chung J, Robinson CH, Yu A, Bamhraz AA, Ewusie JE, Sanger S, Mitsnefes M, Parekh RS, Raina R, Thabane L, Dionne JM, Chanchlani R. Risk of Target Organ Damage in Children With Primary Ambulatory Hypertension: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:1183-1196. [PMID: 36802759 DOI: 10.1161/hypertensionaha.122.20190] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Target organ damage (TOD) such as left ventricular hypertrophy (LVH), abnormal pulse wave velocity, and elevated carotid intima-media thickness are common among adults with hypertension and are associated with overt cardiovascular events. The risk of TOD among children and adolescents with hypertension confirmed by ambulatory blood pressure monitoring is poorly understood. In this systematic review, we compare the risks of TOD among children and adolescents with ambulatory hypertension to normotensive individuals. METHODS A literature search was conducted to include all relevant English-language publications from January 1974 to March 2021. Studies were included if patients underwent 24-hour ambulatory blood pressure monitoring and ≥1 TOD was reported. Ambulatory hypertension was defined by society guidelines. Primary outcome was the risk of TOD, including LVH, left ventricular mass index, pulse wave velocity, and carotid intima-media thickness among children with ambulatory hypertension compared with those with ambulatory normotension. Meta-regression calculated the effect of body mass index on TOD. RESULTS Of 12 252 studies, 38 (n=3609 individuals) were included for analysis. Children with ambulatory hypertension had an increased risk of LVH (odds ratio, 4.69 [95% CI, 2.69-8.19]), elevated left ventricular mass index (pooled difference, 5.13 g/m2.7; [95% CI, 3.78-6.49]), elevated pulse wave velocity (pooled difference, 0.39 m/s [95% CI, 0.20-0.58]), and elevated carotid intima-media thickness (pooled difference, 0.04 mm [95% CI, 0.02-0.05]), compared with normotensive children. Meta-regression showed a significant positive effect of body mass index on left ventricular mass index and carotid intima-media thickness. CONCLUSIONS Children with ambulatory hypertension have adverse TOD profiles, which may increase their risk for future cardiovascular disease. This review highlights the importance of optimizing blood pressure control and screening for TOD in children with ambulatory hypertension. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020189359.
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Affiliation(s)
- Jason Chung
- University of Toronto, Temerty Faculty of Medicine, Ontario, Canada (J.C.)
| | - Cal H Robinson
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.H.R., A.A.B., R.S.P.)
| | - Andrew Yu
- University of Alberta, Faculty of Science, Edmonton, Canada (A.Y.)
| | - Abdulaziz A Bamhraz
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.H.R., A.A.B., R.S.P.)
| | - Joycelyne E Ewusie
- Research Institute - St Joseph's Healthcare Hamilton, Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada. (J.E.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences, McMaster University, Ontario, Canada. (S.S.)
| | - Mark Mitsnefes
- Division of Nephrology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.H.R., A.A.B., R.S.P.)
| | - Rupesh Raina
- Division of Pediatric Nephrology, Department of Pediatrics, Akron Children's Hospital, OH (R.R.)
| | - Lehana Thabane
- Research Institute - St Joseph's Healthcare Hamilton, Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada. (J.E.E., L.T.).,University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, BC Children's Hospital, Vancouver, Canada (J.M.D.)
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
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8
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Gluck CA, Forrest CB, Davies AG, Maltenfort M, Mcdonald JR, Mitsnefes M, Dharnidharka VR, Dixon BP, Flynn JT, Somers MJ, Smoyer WE, Neu A, Hovinga CA, Skversky AL, Eissing T, Kaiser A, Breitenstein S, Furth SL, Denburg MR. Evaluating Kidney Function Decline in Children with Chronic Kidney Disease Using a Multi-Institutional Electronic Health Record Database. Clin J Am Soc Nephrol 2023; 18:173-182. [PMID: 36754006 PMCID: PMC10103199 DOI: 10.2215/cjn.0000000000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/03/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objectives of this study were to use electronic health record data from a US national multicenter pediatric network to identify a large cohort of children with CKD, evaluate CKD progression, and examine clinical risk factors for kidney function decline. METHODS This retrospective cohort study identified children seen between January 1, 2009, to February 28, 2022. Data were from six pediatric health systems in PEDSnet. We identified children aged 18 months to 18 years who met criteria for CKD: two eGFR values <90 and ≥15 ml/min per 1.73 m2 separated by ≥90 days without an intervening value ≥90. CKD progression was defined as a composite outcome: eGFR <15 ml/min per 1.73 m2, ≥50% eGFR decline, long-term dialysis, or kidney transplant. Subcohorts were defined based on CKD etiology: glomerular, nonglomerular, or malignancy. We assessed the association of hypertension (≥2 visits with hypertension diagnosis code) and proteinuria (≥1 urinalysis with ≥1+ protein) within 2 years of cohort entrance on the composite outcome. RESULTS Among 7,148,875 children, we identified 11,240 (15.7 per 10,000) with CKD (median age 11 years, 50% female). The median follow-up was 5.1 (interquartile range 2.8-8.3) years, the median initial eGFR was 75.3 (interquartile range 61-83) ml/min per 1.73 m2, 37% had proteinuria, and 35% had hypertension. The following were associated with CKD progression: lower eGFR category (adjusted hazard ratio [aHR] 1.44 [95% confidence interval (95% CI), 1.23 to 1.69], aHR 2.38 [95% CI, 2.02 to 2.79], aHR 5.75 [95% CI, 5.05 to 6.55] for eGFR 45-59 ml/min per 1.73 m2, 30-44 ml/min per 1.73 m2, 15-29 ml/min per 1.73 m2 at cohort entrance, respectively, when compared with eGFR 60-89 ml/min per 1.73 m2), glomerular disease (aHR 2.01 [95% CI, 1.78 to 2.28]), malignancy (aHR 1.79 [95% CI, 1.52 to 2.11]), proteinuria (aHR 2.23 [95% CI, 1.89 to 2.62]), hypertension (aHR 1.49 [95% CI, 1.22 to 1.82]), proteinuria and hypertension together (aHR 3.98 [95% CI, 3.40 to 4.68]), count of complex chronic comorbidities (aHR 1.07 [95% CI, 1.05 to 1.10] per additional comorbid body system), male sex (aHR 1.16 [95% CI, 1.05 to 1.28]), and younger age at cohort entrance (aHR 0.95 [95% CI, 0.94 to 0.96] per year older). CONCLUSIONS In large-scale real-world data for children with CKD, disease etiology, albuminuria, hypertension, age, male sex, lower eGFR, and greater medical complexity at start of follow-up were associated with more rapid decline in kidney function.
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Affiliation(s)
- Caroline A. Gluck
- Division of Pediatric Nephrology, Nemours Children's Health, Wilmington, Delaware
| | - Christopher B. Forrest
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy Goodwin Davies
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mitchell Maltenfort
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jill R. Mcdonald
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark Mitsnefes
- Division of Pediatric Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Vikas R. Dharnidharka
- Division of Pediatric Nephrology, Hypertension, Pheresis, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Bradley P. Dixon
- Division of Pediatric Nephrology, University of Colorado School of Medicine, Aurora, Colorado
| | - Joseph T. Flynn
- Division of Pediatric Nephrology, Seattle Children's Hospital, Seattle, Washington
| | - Michael J. Somers
- Division of Pediatric Nephrology, Boston Children's, Boston, Massachusetts
| | - William E. Smoyer
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Alicia Neu
- Division of Pediatric Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Collin A. Hovinga
- Clinical and Scientific Development, Institute for Advanced Clinical Trials for Children, Rockville, Maryland
| | - Amy L. Skversky
- Bayer AG, Pharmaceuticals Research & Development, Leverkusen/Wuppertal/Berlin, Germany
| | - Thomas Eissing
- Bayer AG, Pharmaceuticals Research & Development, Leverkusen/Wuppertal/Berlin, Germany
| | - Andreas Kaiser
- Bayer AG, Pharmaceuticals Research & Development, Leverkusen/Wuppertal/Berlin, Germany
| | - Stefanie Breitenstein
- Bayer AG, Pharmaceuticals Research & Development, Leverkusen/Wuppertal/Berlin, Germany
| | - Susan L. Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle R. Denburg
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Goodwin Davies AJ, Xiao R, Razzaghi H, Bailey LC, Utidjian L, Gluck C, Eckrich D, Dixon BP, Deakyne Davies SJ, Flynn JT, Ranade D, Smoyer WE, Kitzmiller M, Dharnidharka VR, Magnusen B, Mitsnefes M, Somers M, Claes DJ, Burrows EK, Luna IY, Furth SL, Forrest CB, Denburg MR. Skeletal Outcomes in Children and Young Adults with Glomerular Disease. J Am Soc Nephrol 2022; 33:2233-2246. [PMID: 36171052 PMCID: PMC9731624 DOI: 10.1681/asn.2021101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking. METHODS This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours. RESULTS We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5). CONCLUSIONS Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.
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Affiliation(s)
- Amy J Goodwin Davies
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanieh Razzaghi
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L Charles Bailey
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Levon Utidjian
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline Gluck
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Daniel Eckrich
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Bradley P Dixon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | | | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | | | - Vikas R Dharnidharka
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Michael Somers
- Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Donna J Claes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Evanette K Burrows
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ingrid Y Luna
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher B Forrest
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R Denburg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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10
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Haley JE, Woodly SA, Daniels SR, Falkner B, Ferguson MA, Flynn JT, Hanevold CD, Hooper SR, Ingelfinger JR, Khoury PR, Lande MB, Martin LJ, Meyers KE, Mitsnefes M, Becker RC, Rosner BA, Samuels J, Tran AH, Urbina EM. Association of Blood Pressure-Related Increase in Vascular Stiffness on Other Measures of Target Organ Damage in Youth. Hypertension 2022; 79:2042-2050. [PMID: 35762327 PMCID: PMC9378473 DOI: 10.1161/hypertensionaha.121.18765] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension-related increased arterial stiffness predicts development of target organ damage (TOD) and cardiovascular disease. We hypothesized that blood pressure (BP)-related increased arterial stiffness is present in youth with elevated BP and is associated with TOD. METHODS Participants were stratified by systolic BP into low- (systolic BP <75th percentile, n=155), mid- (systolic BP ≥80th and <90th percentile, n=88), and high-risk BP categories (≥90th percentile, n=139), based on age-, sex- and height-specific pediatric BP cut points. Clinic BP, 24-hour ambulatory BP monitoring, anthropometrics, and laboratory data were obtained. Arterial stiffness measures included carotid-femoral pulse wave velocity and aortic stiffness. Left ventricular mass index, left ventricular systolic and diastolic function, and urine albumin/creatinine were collected. ANOVA with Bonferroni correction was used to evaluate differences in cardiovascular risk factors, pulse wave velocity, and cardiac function across groups. General linear models were used to examine factors associated with arterial stiffness and to determine whether arterial stiffness is associated with TOD after accounting for BP. RESULTS Pulse wave velocity increased across groups. Aortic distensibility, distensibility coefficient, and compliance were greater in low than in the mid or high group. Significant determinants of arterial stiffness were sex, age, adiposity, BP, and LDL (low-density lipoprotein) cholesterol. Pulse wave velocity and aortic compliance were significantly associated with TOD (systolic and diastolic cardiac function and urine albumin/creatinine ratio) after controlling for BP. CONCLUSIONS Higher arterial stiffness is associated with elevated BP and TOD in youth emphasizing the need for primary prevention of cardiovascular disease.
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Affiliation(s)
| | - Shalayna A Woodly
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | | | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, WA (J.T.F., C.D.H.)
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | - Coral D Hanevold
- Department of Pediatrics, University of Washington, Seattle, WA (J.T.F., C.D.H.)
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | | | | | - Philip R Khoury
- Rady Children's Hospital San Diego, CA (J.E.H.)
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | - Marc B Lande
- University of Rochester Medical Center, Rochester, NY (M.B.L.)
| | - Lisa J Martin
- Rady Children's Hospital San Diego, CA (J.E.H.)
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | | | - Joshua Samuels
- University of Texas Health Sciences Center, Houston (J.S.)
| | - Andrew H Tran
- Nationwide Children's Hospital, Columbus, OH (A.H.T.)
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
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11
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Price JJ, Urbina EM, Carlin K, Becker R, Daniels SR, Falkner BE, Ferguson M, Hanevold C, Hooper SR, Ingelfinger JR, Lande MB, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels J, Flynn JT. Cardiovascular Risk Factors and Target Organ Damage in Adolescents: The SHIP AHOY Study. Pediatrics 2022; 149:186966. [PMID: 35502610 PMCID: PMC9648121 DOI: 10.1542/peds.2021-054201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Development of cardiovascular disease in adults has been directly linked to an adverse metabolic phenotype. While there is evidence that development of these risk factors in childhood persists into adulthood and the development of cardiovascular disease, less is known about whether these risk factors are associated with target organ damage during adolescence. METHODS We collected data from 379 adolescents (mean age 15.5, 60% male) with blood pressure between the 75th and 95th percentile to determine if there is a metabolic phenotype that predicts cardiovascular changes (left ventricular mass, systolic and diastolic function, pulse wave velocity, and renal function). We determined the number of risk factors for cardiovascular disease (hypertension, dyslipidemia, obesity, and insulin resistance) present in each participant. Generalized linear models were constructed to determine if the number of cardiovascular risk factors (CVRFs) were associated with measures of target organ damage. RESULTS The number of CVRFs present were associated with statistically significant differences in increased left ventricular mass index, increased pulse wave velocity, decreased peak longitudinal strain, urine albumin to creatine ratio and echocardiographic parameters of diastolic dysfunction. Generalized linear models showed that dyslipidemia and insulin resistance were independently associated with markers of diastolic dysfunction (P ≤ .05) while increased blood pressure was associated with all makers of target organ damage (P ≤ .03). CONCLUSIONS These data suggest the of the number of CVRFs present is independently associated with early changes in markers of target organ damage during adolescence.
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Affiliation(s)
| | | | | | | | | | - Bonita E Falkner
- Departments of Pediatrics and Medicine, Thomas Jefferson
University, Philadelphia, Pennsylvania
| | | | | | - Stephen R Hooper
- School of Medicine, University of North Carolina, Chapel
Hill, North Carolina
| | | | - Marc B. Lande
- Department of Pediatrics, University of Rochester Medical
Center, Rochester, New York
| | | | - Kevin Meyers
- Childrens Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Bernard Rosner
- Department of MedicineHarvard University, Boston,
Massachusetts
| | - Joshua Samuels
- University of Texas Health Sciences Center, Houston,
Texas
| | - Joseph T. Flynn
- Seattle Children’s Hospital, Seattle,
Washington,Address correspondence to Joseph T. Flynn, MD, 4800 Sandpoint Way
NE Seattle, WA 98105. E-mail:
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12
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Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, Mitsnefes M, Tran A, Zachariah JP. Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e114-e124. [PMID: 35603599 DOI: 10.1161/hyp.0000000000000215] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Use of ambulatory blood pressure monitoring in children and adolescents has markedly increased since publication of the last American Heart Association scientific statement on pediatric ambulatory blood pressure monitoring in 2014. In addition, there has also been significant expansion of the evidence base for use of ambulatory blood pressure monitoring in the pediatric population, including new data linking ambulatory blood pressure levels with the development of blood pressure-related target organ damage. Last, additional data have recently been published that enable simplification of the classification of pediatric ambulatory monitoring studies. This scientific statement presents a succinct review of this new evidence, guidance on optimal application of ambulatory blood pressure monitoring in the clinical setting, and an updated classification scheme for the interpretation of ambulatory blood pressure monitoring in children and adolescents. We also highlight areas of uncertainty where additional research is needed.
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13
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Wenderfer SE, Chang JC, Goodwin Davies A, Luna IY, Scobell R, Sears C, Magella B, Mitsnefes M, Stotter BR, Dharnidharka VR, Nowicki KD, Dixon BP, Kelton M, Flynn JT, Gluck C, Kallash M, Smoyer WE, Knight A, Sule S, Razzaghi H, Bailey LC, Furth SL, Forrest CB, Denburg MR, Atkinson MA. Using a Multi-Institutional Pediatric Learning Health System to Identify Systemic Lupus Erythematosus and Lupus Nephritis: Development and Validation of Computable Phenotypes. Clin J Am Soc Nephrol 2022; 17:65-74. [PMID: 34732529 PMCID: PMC8763148 DOI: 10.2215/cjn.07810621] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Performing adequately powered clinical trials in pediatric diseases, such as SLE, is challenging. Improved recruitment strategies are needed for identifying patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Electronic health record algorithms were developed and tested to identify children with SLE both with and without lupus nephritis. We used single-center electronic health record data to develop computable phenotypes composed of diagnosis, medication, procedure, and utilization codes. These were evaluated iteratively against a manually assembled database of patients with SLE. The highest-performing phenotypes were then evaluated across institutions in PEDSnet, a national health care systems network of >6.7 million children. Reviewers blinded to case status used standardized forms to review random samples of cases (n=350) and noncases (n=350). RESULTS Final algorithms consisted of both utilization and diagnostic criteria. For both, utilization criteria included two or more in-person visits with nephrology or rheumatology and ≥60 days follow-up. SLE diagnostic criteria included absence of neonatal lupus, one or more hydroxychloroquine exposures, and either three or more qualifying diagnosis codes separated by ≥30 days or one or more diagnosis codes and one or more kidney biopsy procedure codes. Sensitivity was 100% (95% confidence interval [95% CI], 99 to 100), specificity was 92% (95% CI, 88 to 94), positive predictive value was 91% (95% CI, 87 to 94), and negative predictive value was 100% (95% CI, 99 to 100). Lupus nephritis diagnostic criteria included either three or more qualifying lupus nephritis diagnosis codes (or SLE codes on the same day as glomerular/kidney codes) separated by ≥30 days or one or more SLE diagnosis codes and one or more kidney biopsy procedure codes. Sensitivity was 90% (95% CI, 85 to 94), specificity was 93% (95% CI, 89 to 97), positive predictive value was 94% (95% CI, 89 to 97), and negative predictive value was 90% (95% CI, 84 to 94). Algorithms identified 1508 children with SLE at PEDSnet institutions (537 with lupus nephritis), 809 of whom were seen in the past 12 months. CONCLUSIONS Electronic health record-based algorithms for SLE and lupus nephritis demonstrated excellent classification accuracy across PEDSnet institutions.
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Affiliation(s)
- Scott E. Wenderfer
- Pediatric Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Joyce C. Chang
- Pediatric Rheumatology, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy Goodwin Davies
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ingrid Y. Luna
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Scobell
- Pediatric Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas,Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cora Sears
- Pediatric Rheumatology, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bliss Magella
- Pediatric Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mitsnefes
- Pediatric Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Brian R. Stotter
- Pediatric Nephrology, Hypertension and Pheresis, St. Louis Children’s Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Vikas R. Dharnidharka
- Pediatric Nephrology, Hypertension and Pheresis, St. Louis Children’s Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Katherine D. Nowicki
- Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bradley P. Dixon
- Pediatric Nephrology, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan Kelton
- Pediatrics, University of Washington, Seattle, Washington,Nephrology, Seattle Children’s Hospital, Seattle, Washington
| | - Joseph T. Flynn
- Pediatrics, University of Washington, Seattle, Washington,Nephrology, Seattle Children’s Hospital, Seattle, Washington
| | - Caroline Gluck
- Pediatric Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Mahmoud Kallash
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - William E. Smoyer
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Andrea Knight
- Pediatric Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sangeeta Sule
- Pediatric Rheumatology, George Washington University, Children’s National Medical Center, Washington, DC
| | - Hanieh Razzaghi
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L. Charles Bailey
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan L. Furth
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher B. Forrest
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R. Denburg
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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14
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Mitsnefes M, Flynn JT, Brady T, Baker-Smith C, Daniels SR, Hayman LL, Tran A, Zachariah JP, Urbina EM. Pediatric Ambulatory Blood Pressure Classification: The Case for a Change. Hypertension 2021; 78:1206-1210. [PMID: 34601972 PMCID: PMC8516706 DOI: 10.1161/hypertensionaha.121.18138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In 1997, Soergel et al1 published the first set of normative values for ambulatory blood pressure monitoring (ABPM) in children. Since then, the clinical utility of ABPM has increased dramatically, and now, ABPM is accepted as the standard method to confirm the diagnosis of hypertension in children. Despite significant progress in the field of pediatric ABPM, many important questions remain unanswered. One of the most controversial issues is how to define ambulatory hypertension in children. The purpose of this review is to discuss the limitations of the current pediatric ABPM classification scheme and to provide the justification and rationale for a new classification.
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Affiliation(s)
- Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (M.M., E.M.U.)
| | - Joseph T Flynn
- University of Washington and Seattle Children's Hospital (J.T.F.)
| | - Tammy Brady
- Johns Hopkins University, Baltimore, MD (T.B.)
| | | | | | | | - Andrew Tran
- Nationwide Children's Hospital, The Ohio State University, Columbus (A.T.)
| | | | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (M.M., E.M.U.)
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15
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Ku E, Hsu RK, Johansen KL, McCulloch CE, Mitsnefes M, Grimes BA, Liu KD. Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data. PLoS Med 2021; 18:e1003546. [PMID: 33606673 PMCID: PMC7935284 DOI: 10.1371/journal.pmed.1003546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/05/2021] [Accepted: 01/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US. METHODS AND FINDINGS We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data. CONCLUSIONS In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.
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Affiliation(s)
- Elaine Ku
- University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America
- University of California San Francisco, Division of Pediatric Nephrology, Department of Pediatrics, San Francisco, California, United States of America
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America
- * E-mail:
| | - Raymond K. Hsu
- University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America
| | - Kirsten L. Johansen
- Hennepin Healthcare and University of Minnesota, Department of Medicine, Division of Nephrology, Minneapolis, Minnesota, United States of America
| | - Charles E. McCulloch
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America
| | - Mark Mitsnefes
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, Cincinnati, Ohio, United States of America
| | - Barbara A. Grimes
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States of America
| | - Kathleen D. Liu
- University of California San Francisco, Division of Nephrology, Department of Medicine, San Francisco, California, United States of America
- University of California San Francisco, Department of Anesthesia and Perioperative Care, San Francisco, California, United States of America
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16
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Sgambat K, Roem J, Brady TM, Flynn JT, Mitsnefes M, Samuels JA, Warady BA, Furth SL, Moudgil A. Social Determinants of Cardiovascular Health in African American Children With CKD: An Analysis of the Chronic Kidney Disease in Children (CKiD) Study. Am J Kidney Dis 2021; 78:66-74. [PMID: 33418013 DOI: 10.1053/j.ajkd.2020.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/03/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE To identify differences in socioeconomic factors (SES) and subclinical cardiovascular disease (CVD) markers by race among Chronic Kidney Disease in Children (CKiD) participants and determine whether differences in CVD markers persist after adjusting for SES. STUDY DESIGN Analysis of 3,103 visits with repeated measures from 628 children (497 White participants; 131 African American participants) enrolled in the CKiD study. SETTING & PARTICIPANTS Children with mild-moderate CKD with at least 1 cardiovascular (CV) parameter (ambulatory blood pressure, left ventricular mass index [LVMI], or lipid profile) measured. EXPOSURE African American race. OUTCOMES Ambulatory hypertension, LVMI, triglycerides, high-density lipoprotein cholesterol. ANALYTICAL APPROACH Due to increased CV risks of glomerular disease, the analysis was stratified by CKD cause. Inverse probability weighting was used to adjust for SES (health insurance, household income, maternal education, food insecurity, abnormal birth history). Linear and logistic regression were used to evaluate association of race with CV markers. RESULTS African American children were disproportionately affected by adverse SES. African Americans with nonglomerular CKD had more instances of ambulatory hypertension and higher LVMI but more favorable lipid profiles. After adjustment for SES, age, and sex, the magnitude of differences in these CV markers was attenuated but remained statistically significant. Only LVMI differed by race in the glomerular CKD group, despite adjustment for SES. LIMITATIONS Study design limits causal inference. CONCLUSION African American children with CKD are disproportionately affected by socioeconomic disadvantages compared with White children. The degree to which CV markers differ by race is influenced by disease etiology. African Americans with nonglomerular CKD have increased LVMI, more ambulatory hypertension, and favorable lipid profile, but attenuation in magnitude after adjustment for SES was observed. African Americans with glomerular CKD had increased LVMI, which persisted after SES adjustment. As many social determinants of health were not captured, future research should examine effects of systemic racism on CV health in this population.
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Affiliation(s)
- Kristen Sgambat
- Division of Nephrology, Childrens' National Hospital, Washington DC.
| | - Jennifer Roem
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph T Flynn
- Department of Pediatrics, Division of Nephrology, Children's Hospital, University of Washington, Seattle, WA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Joshua A Samuels
- Division of Pediatric Nephrology and Hypertension, McGovern Medical School at University of Texas Health, Houston, TX
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - Susan L Furth
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Asha Moudgil
- Division of Nephrology, Childrens' National Hospital, Washington DC
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17
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Madueme P, Mitsnefes M. Response to letter to the editor. Pediatr Nephrol 2020; 35:2013-2014. [PMID: 32647976 DOI: 10.1007/s00467-020-04699-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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18
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Madueme PC, Ng DK, Guju L, Longshore L, Moore V, Jefferies L, Warady BA, Furth S, Mitsnefes M. Correction to: Aortic dilatation in children with mild to moderate chronic kidney disease. Pediatr Nephrol 2020; 35:2017. [PMID: 32642934 DOI: 10.1007/s00467-020-04665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article unfortunately contained a mistake.
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Affiliation(s)
- Peace C Madueme
- The Cardiac Center, Nemours Children's Hospital, 13535 Nemours, Parkway, Orlando, FL, 32827, USA.
| | - Derek K Ng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke Guju
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren Longshore
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Vicky Moore
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lynn Jefferies
- Methodist University of Tennessee Cardiovascular Institute, Memphis, TN, USA
| | | | - Susan Furth
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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19
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Hamdani G, Ferguson MA, Lande MB, Meyers K, Mitsnefes M, Samuels JA, Flynn JT, Urbina EM. Abstract 6: Comparison Between Ambulatory BP Percentile And Load As Predictors Of Target Organ Damage In Youth. Hypertension 2020. [DOI: 10.1161/hyp.76.suppl_1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ambulatory BP (ABP) is increasingly used to confirm the diagnosis of hypertension. Pediatric but not adult guidelines consider BP load (% readings above 95
th
%ile) in risk-stratification of the ABP phenotype. We compared ABP sex- and height- specific percentile and BP load as predictors of left ventricular hypertrophy (LVH) in youth. We measured casual BP, ABP, anthropometrics, and calculated LV mass by echo as (g)/height (m)
2.7
(LVMI) in 357 adolescents (mean age 15.5
+
1.7 years, 63% white, 59% male). ABPM was performed with the Ontrak device (Spacelabs Inc., Snoqualmie, WA). ABP index was defined as mean ABP/sex- and height-specific 95
th
%ile. LVH was defined as LVMI ≥38.6 (pediatric cut-point). Logistic regression was used to assess different ABP measures as predictors of LVH. Sensitivity and specificity of different ABP cut points as predictors of LVH were calculated. Seventy (19.6%) participants had LVH. Systolic 24-hour, wake and sleep ABP indices as well as 24-hour SBP load were all significantly associated with LVH, while wake and sleep SBP load were not. When adjusted for BMI percentile and sex, only the associations between ABP indices and LVH remained statistically significant (table). SBP percentiles also had better balanced sensitivities and specificities in predicting LVH (24-hour 65
th
percentile: 63% and 59%; wake 70
th
percentile: 54% and 62%; sleep 75
th
percentile: 60% and 61%). There was no significant association between diastolic BP measures and LVH. We conclude that there is no significant contribution of BP load in predicting LVH in youth. Systolic ABP percentiles lower than the commonly used 95
th
percentile are the best predictors of LVH in this population.
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Affiliation(s)
- Gilad Hamdani
- Schneider Children's Med Canter, Petah Tikva, Israel
| | | | | | - Kevin Meyers
- Children's Hosp of Philadelphia, Drexel Hill, PA
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20
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Brady TM, Roem J, Cox C, Schneider MF, Wilson AC, Furth SL, Warady BA, Mitsnefes M. Adiposity, Sex, and Cardiovascular Disease Risk in Children With CKD: A Longitudinal Study of Youth Enrolled in the Chronic Kidney Disease in Children (CKiD) Study. Am J Kidney Dis 2020; 76:166-173. [PMID: 32389356 PMCID: PMC7387195 DOI: 10.1053/j.ajkd.2020.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/17/2020] [Indexed: 12/18/2022]
Abstract
RATIONALE & OBJECTIVE Traditional and nontraditional cardiovascular disease risk factors are highly prevalent in children with chronic kidney disease (CKD). We examined the longitudinal association of adiposity with cardiac damage among children with CKD and explored whether this association was modified by sex. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study at 49 pediatric nephrology centers across North America. EXPOSURE Age- and sex-specific body mass index (BMI) z score. OUTCOME Age- and sex-specific left ventricular mass index (LVMI) z score and left ventricular hypertrophy (LVH). ANALYTICAL APPROACH Longitudinal analyses using mixed-effects models to estimate sex-specific associations of BMI z scores with LVMI z score and with LVH, accounting for repeated measurements over time. RESULTS Among 725 children with 2,829 person-years of follow-up, median age was 11.0 years and median estimated glomerular filtration rate was 52.6mL/min/1.73m2. Nearly one-third of both boys and girls were overweight or obese, median LVMI z score was 0.18 (IQR: -0.67, 1.08), and 11% had LVH. Greater BMI z scores were independently associated with greater LVMI z scores and greater odds of LVH. For each 1-unit higher BMI z score, LVMI z score was 0.24 (95% CI, 0.17-0.31) higher in boys and 0.38 (95% CI, 0.29-0.47) higher in girls (Pinteraction = 0.01). For each 1-unit higher BMI z score, the odds of LVH was 1.5-fold (95% CI, 1.1-2.1) higher in boys and 3.1-fold (95% CI, 1.8-4.4) higher in girls (Pinteraction = 0.005). LIMITATIONS Not all children had repeated measurements. LVH is a surrogate and not a hard cardiac outcome. The observational design limits causal inference. CONCLUSIONS In children, adiposity is independently associated with the markers of cardiac damage, LVMI z score and LVH. This association is stronger among girls than boys. Pediatric overweight and obesity may therefore have a substantial impact on cardiovascular risk among children with CKD.
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Affiliation(s)
- Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jennifer Roem
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amy C Wilson
- J.W. Riley Hospital for Children, Indianapolis, IN
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Hospital, Kansas City, MO
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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21
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Tran AH, Flynn JT, Becker RC, Daniels SR, Falkner BE, Ferguson M, Hanevold CD, Hooper SR, Ingelfinger JR, Lande MB, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels JA, Urbina EM. Subclinical Systolic and Diastolic Dysfunction Is Evident in Youth With Elevated Blood Pressure. Hypertension 2020; 75:1551-1556. [PMID: 32362230 PMCID: PMC7266265 DOI: 10.1161/hypertensionaha.119.14682] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is associated with cardiovascular events in adults. Subclinical changes to left ventricular strain and diastolic function have been found before development of decreased left ventricular ejection fraction and cardiovascular events. Our objective was to study effects of blood pressure (BP) on ventricular function in youth across the BP spectrum. Vital signs and labs were obtained in 346 participants aged 11 to 19 years who had BP categorized as low-risk (N=144; systolic BP <75th percentile), mid-risk (N=83; systolic BP ≥80th and <90th percentile), and high-risk (N=119; systolic BP ≥90th percentile). Echocardiography was performed to assess left ventricular strain and diastolic function. Differences between groups were analyzed by ANOVA. General linear models were constructed to determine independent predictors of systolic and diastolic function. Mid-risk and high-risk participants had greater adiposity and more adverse metabolic labs (lower HDL [high-density lipoprotein], higher glucose, and higher insulin) than the low-risk group. Mid-risk and high-risk participants had significantly lower left ventricular ejection fraction and peak global longitudinal strain than the low-risk group (both P≤0.05). The E/e' ratio was higher in the high-risk group versus the low-risk and mid-risk groups, and the e'/a' ratio was lower in the high-risk versus the low-risk group (both P≤0.05). BP and adiposity were statistically significant determinants of left ventricular systolic and diastolic function. Subclinical changes in left ventricular systolic and diastolic function can be detected even at BP levels below the hypertensive range as currently defined.
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Affiliation(s)
- Andrew H Tran
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.).,The Ohio State University, OH (A.H.T.).,Nationwide Children's Hospital, Columbus, OH (A.H.T.)
| | | | - Richard C Becker
- University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
| | | | | | | | | | - Stephen R Hooper
- School of Medicine, University of North Carolina at Chapel Hill (S.R.H.)
| | | | - Marc B Lande
- University of Rochester Medical Center, New York (M.B.L.)
| | - Lisa J Martin
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
| | | | | | - Elaine M Urbina
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
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22
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Bjornstad P, Hughan K, Kelsey MM, Shah AS, Lynch J, Nehus E, Mitsnefes M, Jenkins T, Xu P, Xie C, Inge T, Nadeau K. Effect of Surgical Versus Medical Therapy on Diabetic Kidney Disease Over 5 Years in Severely Obese Adolescents With Type 2 Diabetes. Diabetes Care 2020; 43:187-195. [PMID: 31685489 PMCID: PMC6925577 DOI: 10.2337/dc19-0708] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/30/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. Glycemic control, BMI, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and prevalence of hyperfiltration (eGFR ≥135 mL/min/1.73 m2) and elevated UAE (≥30 mg/g) were assessed annually. RESULTS Participants with T2D from Teen-LABS (n = 30, mean ± SD age, 16.9 ± 1.3 years; 70% female; 60% white; BMI 54.4 ± 9.5 kg/m2) and TODAY (n = 63, age 15.3 ± 1.3 years; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.
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Affiliation(s)
- Petter Bjornstad
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Kara Hughan
- University of Pittsburgh and UPMC Children's Hospital Pittsburgh, Pittsburgh, PA
| | - Megan M Kelsey
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Amy S Shah
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Jane Lynch
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Edward Nehus
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Mark Mitsnefes
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Todd Jenkins
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Peixin Xu
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Changchun Xie
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Thomas Inge
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Kristen Nadeau
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
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23
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Abstract
Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician's initial management of a hypertensive crisis. The main aim of the treatment of hypertensive crisis is the prevention or treatment of life-threatening complications of hypertension-induced organ dysfunction, including neurologic, ophthalmologic, renal, and cardiac complications. While the treatment strategy must be directed toward the immediate reduction of BP to reduce the hypertensive damage to these organs, it should not be at a too fast rate to cause hypoperfusion of vital organs by an excessively rapid reduction of BP. Thus, intravenous continuous infusions rather than intravenous boluses of antihypertensive medications should be the preferable mode of initial treatment of children with hypertensive emergency.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics and Biomedical Center, 2nd Faculty of Medicine and Faculty of Medicine in Pilsen, Charles University in Prague, V Uvalu 84, 15006, Prague 5, Czech Republic. .,Motol University Hospital, V Uvalu 84, 15006, Prague 5, Czech Republic.
| | - Gilad Hamdani
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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24
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Urbina EM, Mendizábal B, Becker RC, Daniels SR, Falkner BE, Hamdani G, Hanevold C, Hooper SR, Ingelfinger JR, Lanade M, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels J, Flynn JT. Association of Blood Pressure Level With Left Ventricular Mass in Adolescents. Hypertension 2019; 74:590-596. [PMID: 31327264 DOI: 10.1161/hypertensionaha.119.13027] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80-<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m2.7; LVH: L=13%, M=21%, H=27%, all P<0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m2.7). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.
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Affiliation(s)
- Elaine M Urbina
- From the Division of Preventive Cardiology (E.M.U.), Cincinnati Children's Hospital Medical Center, OH
| | | | - Richard C Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.C.B.)
| | - Steve R Daniels
- Department of Pediatrics, Denver Children's Hospital, CO (S.D.)
| | - Bonita E Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.E.F.)
| | - Gilad Hamdani
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel (G.H.)
| | - Coral Hanevold
- Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.)
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine (S.R.H.)
| | - Julie R Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children, Massachusetts General Hospital, Boston (J.R.I.)
| | - Marc Lanade
- Department of Pediatrics, University of Rochester Medical Center, NY (M.L.)
| | - Lisa J Martin
- Division of Human Genetics (L.J.M.), Cincinnati Children's Hospital Medical Center, OH
| | - Kevin Meyers
- Division of Nephrology and Hypertension, Children's Hospital of Philadelphia, PA (K.M.)
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension (M.M.), Cincinnati Children's Hospital Medical Center, OH
| | | | - Joshua Samuels
- Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas in Houston (J.S.)
| | - Joseph T Flynn
- Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.)
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25
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Abstract
The lifespan of children with advanced chronic kidney disease (CKD), although improved over the past 2 decades, remains low compared with the general pediatric population. Similar to adults with CKD, cardiovascular disease accounts for a majority of deaths in children with CKD because these patients have a high prevalence of traditional and uremia-related risk factors for cardiovascular disease. The cardiovascular alterations that cause these terminal events begin early in pediatric CKD. Initially, these act to maintain hemodynamic homeostasis. However, as the disease progresses, these modifications are unable to sustain cardiovascular function in the long term, leading to left ventricular failure, depressed cardiorespiratory fitness, and sudden death. In this review, we discuss the prevalence of the risk factors associated with cardiovascular disease in pediatric patients with CKD, the pathophysiology that stimulates these changes, the cardiac and vascular adaptations that occur in these patients, and management of the cardiovascular risk in these patients.
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Affiliation(s)
- Donald J Weaver
- Division of Nephrology and Hypertension, Levine Children's Hospital, Charlotte, NC
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Hamdani G, Flynn JT, Becker RC, Daniels SR, Falkner B, Hanevold CD, Ingelfinger JR, Lande MB, Martin LJ, Meyers KE, Mitsnefes M, Rosner B, Samuels JA, Urbina EM. Prediction of Ambulatory Hypertension Based on Clinic Blood Pressure Percentile in Adolescents. Hypertension 2019; 72:955-961. [PMID: 30354718 PMCID: PMC7202372 DOI: 10.1161/hypertensionaha.118.11530] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ambulatory blood pressure (BP) monitoring provides a more precise measure of BP status than clinic BP and is currently recommended in the evaluation of high BP in children and adolescents. However, ambulatory BP monitoring may not always be available. Our aim was to determine the clinic BP percentile most likely to predict ambulatory hypertension. We evaluated clinic and ambulatory BP in 247 adolescents (median age, 15.7 years; 63% white; 54% male). Clinic BP percentile (based on the fourth report and the 2017 American Academy of Pediatrics clinical practice guidelines) and ambulatory BP status (normal versus hypertension) were determined by age-, sex-, and height-specific cut points. Sensitivity and specificity of different clinic BP percentiles and cutoffs to predict ambulatory hypertension were calculated. Forty (16%) and 67 (27%) patients had systolic hypertension based on the fourth report and the 2017 guidelines, respectively, whereas 38 (15%) had wake ambulatory systolic hypertension. The prevalence of ambulatory wake systolic hypertension increased across clinic systolic BP percentiles, from 3% when clinic systolic BP was <50th percentile to 41% when ≥95th percentile. The 2017 guidelines' 85th systolic percentile had similar sensitivity (86.8%) and better specificity (57.4% versus 48.1%) than elevated BP (≥90th percentile or ≥120 mm Hg) to diagnose ambulatory hypertension. When evaluating adolescents for hypertension, 2017 guidelines' clinic systolic 85th percentile may be the optimal threshold at which to perform ambulatory BP monitoring.
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Affiliation(s)
- Gilad Hamdani
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | - Joseph T Flynn
- Seattle Children's Hospital, Washington (J.T.F., C.D.H.)
| | | | | | - Bonita Falkner
- Thomas Jefferson University Hospital, Philadelphia, PA (B.F.)
| | | | | | - Marc B Lande
- University of Rochester Medical Center, New York (M.B.L.)
| | - Lisa J Martin
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | - Bernard Rosner
- Harvard TH Chan School of Public Health, Boston, MA (B.R.)
| | | | - Elaine M Urbina
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
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27
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Mendizábal B, Urbina EM, Becker R, Daniels SR, Falkner BE, Hamdani G, Hanevold CD, Hooper SR, Ingelfinger JR, Lande M, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels JA, Flynn JT. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth). Hypertension 2019; 72:625-631. [PMID: 29987102 DOI: 10.1161/hypertensionaha.118.11434] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although hypertension is identifiable in children and adolescents, there are many knowledge gaps on how to best define and manage high blood pressure in the young. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth) is being conducted to address these knowledge gaps. Five hundred adolescents will be recruited and will undergo ambulatory blood pressure monitoring, echocardiographic, vascular, and cognitive assessments, as well as epigenetic studies to identify mechanisms that underlie the development of hypertensive target organ damage. Details of the design and methods that will be utilized in SHIP-AHOY are presented here, as well as baseline characteristics of the first 264 study participants. The primary aim of the study is to develop a risk-based definition of hypertension in the young that will result in better understanding of the transition from blood pressure in youth to adult cardiovascular disease.
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Affiliation(s)
| | | | - Richard Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.B.)
| | - Stephen R Daniels
- Department of Pediatrics, Denver Children's Hospital, Aurora, CO (S.R.D.)
| | - Bonita E Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.E.F.)
| | | | - Coral D Hanevold
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.D.H., J.T.F.)
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill (S.R.H.)
| | - Julie R Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children at Massachusetts General Hospital (J.R.I.)
| | - Marc Lande
- Department of Pediatrics, University of Rochester Medical Center, NY (M.L.)
| | - Lisa J Martin
- Human Genetics (L.J.M.), Cincinnati Children's Hospital Medical Center, OH
| | - Kevin Meyers
- Pediatric Nephrology, Children's Hospital of Philadelphia, PA (K.M.)
| | - Mark Mitsnefes
- From the Divisions of Preventive Cardiology (B.M., E.M.U.)
| | - Bernard Rosner
- Department of Medicine, Harvard Medical School, Boston, MA (B.R.)
| | - Joshua A Samuels
- Pediatric Nephrology and Hypertension, University of Texas Health Science Center at Houston (J.A.S.)
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.D.H., J.T.F.)
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Abstract
Obesity is a leading cause of chronic kidney disease. Children with severe obesity have an increased prevalence of early kidney abnormalities and are at high risk to develop kidney failure in adulthood. The pathophysiology of obesity-related kidney disease is incompletely understood, although the postulated mechanisms of kidney injury include hyperfiltration, adipokine dysregulation, and lipotoxic injury. An improved understanding of the long-term effects of obesity on kidney health is essential treat the growing epidemic of obesity-related kidney disease. The purpose of this article is to review the epidemiology, pathophysiology, clinical features, and management of obesity-related kidney disease in children and adolescents.
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Affiliation(s)
- Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, USA.
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, USA
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29
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Brady TM, Roem J, Cox C, Schneider M, Wilson A, Furth S, Warady B, Mitsnefes M. Abstract P393: Sex Modifies the Longitudinal Association of Adiposity With Left Ventricular Hypertrophy Among Children With Chronic Kidney Disease. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.p393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Adiposity, not blood pressure (BP), is associated with left ventricular hypertrophy (LVH) among hypertensive children without chronic kidney disease (CKD). We aimed to determine the longitudinal association of BMI z-score with LVH and left ventricular mass index (LVMI) among children with CKD.
Methods:
696 participants of the Chronic Kidney Disease in Children study with echocardiography results who contributed a total of 1,300 visits were included. Mixed models, adjusting for repeated visits with a random subject effect, were used to determine the longitudinal association of body mass index (BMI) z-score with LVMI and LVH (LVMI> age-sex specific 95
th
%ile). Models were adjusted for age, sex, race, systolic and diastolic BP z-score, glomerular diagnosis, time with CKD, glomerular filtration rate and calcium*phosphorus product and accounted for informative censoring.
Results:
Baseline characteristics are in the table. Among females, a 1 unit increase in BMI z-score was associated with an 8.5% increase in LVMI and 3.4 greater odds of LVH, whereas with boys, a 1 unit increase in BMI z-score was associated with a 5.2% increase in LVMI and a 1.4 greater odds of LVH (p<0.05 for all).
Conclusions:
Among children with mild-moderate CKD, adiposity is independently associated with LVMI and LVH over time. This association is greater among females, a finding that may have future clinical and research implications.
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Affiliation(s)
| | | | | | | | - Amy Wilson
- J.W. Riley Hosp for Children, Indianapolis, IN
| | - Susan Furth
- Children's Hosp of Philadelphia, Philadelphia, PA
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30
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Sgambat K, Roem J, Mitsnefes M, Portale AA, Furth S, Warady B, Moudgil A. Waist-to-height ratio, body mass index, and cardiovascular risk profile in children with chronic kidney disease. Pediatr Nephrol 2018; 33:1577-1583. [PMID: 29872963 PMCID: PMC6281775 DOI: 10.1007/s00467-018-3987-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cardiovascular (CV) risk is high in children with chronic kidney disease (CKD), and further compounded in those who are overweight. Children with CKD have a unique body habitus not accurately assessed by body mass index (BMI). Waist-to-height ratio (WHr), a better predictor of CV risk in populations with short stature, has not been investigated in children with CKD. METHODS Analysis of 1723 visits of 593 participants enrolled in the Chronic Kidney Disease in Children (CKiD) study was conducted. CKiD participants had BMI and WHr measured and classified as follows: (1) lean (WHr ≤ 0.49, BMI < 85th percentile); (2) WHr-overweight (WHr > 0.49, BMI < 85th percentile); (3) BMI-overweight (WHr ≤ 0.49, BMI ≥ 85th percentile); or (4) overweight by both BMI and WHr. Left ventricular mass index (LVMI), fasting lipids, fibroblast growth factor 23 (FGF23), blood pressure, and glucose were measured as markers of CV risk. Linear mixed-effects regression was used to evaluate differences in CV markers between overweight and lean groups. RESULTS Participants were 12.2 years old, 60% male, and 17% African-American. Approximately 15% were overweight by WHr but not by BMI. Overweight status by WHr-only or both WHr and BMI was associated with lower high-density lipoprotein (HDL) and higher LVMI, triglycerides, and non-HDL cholesterol compared to lean. CV markers of participants overweight by BMI-only were similar to those of lean children. CONCLUSIONS WHr-adiposity is associated with an adverse CV risk profile in children with CKD. A significant proportion of children with central adiposity are missed by BMI. WHr should be utilized as a screening tool for CV risk in this population.
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Affiliation(s)
- Kristen Sgambat
- Department of Nephrology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
| | - Jennifer Roem
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Susan Furth
- The Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA, USA
| | | | - Asha Moudgil
- Department of Nephrology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA
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31
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Barletta GM, Pierce C, Mitsnefes M, Samuels J, Warady BA, Furth S, Flynn J. Is Blood Pressure Improving in Children With Chronic Kidney Disease? A Period Analysis. Hypertension 2018; 71:444-450. [PMID: 29295853 PMCID: PMC5812788 DOI: 10.1161/hypertensionaha.117.09649] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/16/2017] [Accepted: 12/05/2017] [Indexed: 12/18/2022]
Abstract
Uncontrolled hypertension in children with chronic kidney disease (CKD) has been identified as one of the main factors contributing to progression of CKD and increased risk for cardiovascular disease. Recent efforts to achieve better blood pressure (BP) control have been recommended. The primary objective of this analysis was to compare BP control over 2 time periods among participants enrolled in the CKiD study (Chronic Kidney Disease in Children). Casual BP and 24-hour ambulatory BP monitor data were compared among 851 participants during 2 time periods: January 1, 2005, through July 1, 2008 (period 1, n=345), and July 1, 2010, through December 31, 2013 (period 2, n=506). Multivariable logistic regression to model the propensity of a visit record being in period 2 as a function of specific predictors was performed. After controlling for confounding variables (age, sex, race, socioeconomics, CKD duration, glomerular filtration rate, proteinuria, body mass index, growth failure, and antihypertensives), no significant differences were detected between time periods with respect to casual BP status (prehypertension: 15% versus 15%; uncontrolled hypertension: 18% versus 17%; P=0.87). Analysis of ambulatory BP monitor data demonstrated higher ambulatory BP indices, most notably masked hypertension in period 2 (36% versus 49%; P<0.001). Average sleep BP index (P<0.05) and sleep BP loads (P<0.05) were higher in period 2. Despite publication of hypertension recommendations and guidelines for BP control in patients with CKD, this study suggests that hypertension remains undertreated and under-recognized in children with CKD. This analysis also underscores the importance of routine ambulatory BP monitor assessment in children with CKD.
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Affiliation(s)
- Gina-Marie Barletta
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.).
| | - Christopher Pierce
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.)
| | - Mark Mitsnefes
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.)
| | - Joshua Samuels
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.)
| | - Bradley A Warady
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.)
| | - Susan Furth
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.)
| | - Joseph Flynn
- From the Pediatric Kidney Disease and Hypertension Centers, Phoenix, AZ (G.-M.B.); Johns Hopkins University, Baltimore, MD (C.P.); Cincinnati Children's Hospital, OH (M.M.); McGovern Medical School UT Health, Houston, TX (J.S.); Children's Mercy Hospital, Kansas City, MO (B.A.W.); Children's Hospital of Philadelphia, PA (S.F.); and Seattle Children's Hospital, Seattle, WA (J.F.)
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Davis S, Nehus E, Inge T, Zhang W, Setchell K, Mitsnefes M. Effect of bariatric surgery on urinary sphingolipids in adolescents with severe obesity. Surg Obes Relat Dis 2017; 14:446-451. [PMID: 29396280 DOI: 10.1016/j.soard.2017.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Untreated severe obesity of adolescents is associated with abnormal kidney function and development of chronic kidney disease. Lipotoxicity due to lipid accumulation in glomeruli might be an important mechanism in the progression of kidney disease in obesity. OBJECTIVE To assess subclinical glomerular injury by measuring urinary sphingolipids in adolescents with severe obesity before and after weight loss surgery. We hypothesized that the levels of urinary sphingolipids would be elevated at baseline and improve after weight reduction. SETTING Cincinnati Children's Hospital Medical Center, University of Cincinnati. METHODS Ten adolescents undergoing bariatric surgery with no microalbuminuria and normal kidney function were selected. Urinary sphingolipids (ceramides, glycosphingolipids, and sphingomyelins) were quantified using ultra performance liquid chromatography electrospray ionization tandem mass spectrometry at baseline and 1 year postoperatively. The levels of sphingolipids were compared with lean and moderately obese controls. RESULTS Participants with severe obesity had a mean baseline body mass index of 50 kg/m2 that decreased to 36 kg/m2 at 1 year postsurgery (28% reduction). Almost all urinary ceramides, glycosphingolipids, and sphingomyelin species were significantly elevated in participants with severe obesity compared with controls at baseline (P<.01). One year after weight loss surgery, levels of urinary sphingolipids improved but were still significantly elevated compared with controls. CONCLUSIONS Our study indicates that severe obesity is associated with increased urinary excretion of sphingolipids despite the absence of microalbuminuria or decreased kidney function. Urinary sphingolipids may therefore represent a marker of early (subclinical) glomerular injury in adolescents with severe obesity.
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Affiliation(s)
- Stephanie Davis
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas Inge
- Division of Surgery, Colorado Children's Hospital, Denver, Colorado
| | - Wujuan Zhang
- Clinical Mass Spectrometry laboratory, Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kenneth Setchell
- Clinical Mass Spectrometry laboratory, Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Ku E, Kopple JD, McCulloch CE, Warady BA, Furth SL, Mak RH, Grimes BA, Mitsnefes M. Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Am J Kidney Dis 2017; 71:648-656. [PMID: 29132947 DOI: 10.1053/j.ajkd.2017.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Anorexia and malnutrition are associated with poor outcomes in children with chronic kidney disease (CKD). STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS We assessed changes in body mass index (BMI) as kidney function declines and its association with risk for end-stage renal disease (ESRD) among 854 participants followed between 2005 to 2013 in the CKD in Children (CKiD) Study. PREDICTORS Repeated measurements of estimated glomerular filtration rate (eGFR) by serum creatinine concentration in our trajectory analysis using mixed models; change in BMI z score (per year) after eGFR decreased to <35mL/min/1.73m2 in logistic regression models. OUTCOMES Repeated measurements of BMI z score (as a reflection of weight status) in our trajectory analysis; ESRD in logistic regression models. RESULTS During a mean longitudinal follow-up of 3.4 years, BMI z scores remained stable until eGFR decreased to <35mL/min/1.73m2. When eGFR decreased to <35mL/min/1.73m2, a mean decline in BMI z score of 0.13 (95% CI, 0.09-0.17) was noted with each 10-mL/min/1.73m2 further decline in eGFR. This was statistically significantly different from the weight trajectory when eGFR was ≥35mL/min/1.73 m2 (P<0.001). Among children and adolescents with significant weight loss (defined as decline in BMI z score > 0.2 per year) after eGFR decreased to <35mL/min/1.73m2, the odds of ESRD was 3.28 (95% CI, 1.53-7.05) times greater compared with participants with stable BMI z scores (BMI z score change per year of 0-0.1). LIMITATIONS Observational nature of our study, lack of longitudinal assessments of inflammatory markers. CONCLUSIONS In children and adolescents with CKD, weight loss mostly occurs when eGFR decreases to <35mL/min/1.73m2, and this weight loss was associated with higher risk for ESRD. Further studies are needed to define the reasons for the association between weight loss and more rapid progression to ESRD in children and adolescents.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
| | - Joel D Kopple
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Susan L Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert H Mak
- Division of Pediatric Nephrology, Department of Pediatrics, Rady Children's Hospital, La Jolla, CA
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Mark Mitsnefes
- Division of Pediatric Nephrology, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH
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Laskin BL, Huang G, King E, Geary DF, Licht C, Metlay JP, Furth SL, Kimball T, Mitsnefes M. Short, frequent, 5-days-per-week, in-center hemodialysis versus 3-days-per week treatment: a randomized crossover pilot trial through the Midwest Pediatric Nephrology Consortium. Pediatr Nephrol 2017; 32:1423-1432. [PMID: 28389745 PMCID: PMC5485844 DOI: 10.1007/s00467-017-3656-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND No controlled trials in children with end-stage kidney disease have assessed the benefits of more frequently administered hemodialysis (HD). METHODS We conducted a multicenter, crossover pilot trial to determine if short, more frequent (5 days per week) in-center HD was feasible and associated with improvements in blood pressure compared with three conventional HD treatments per week. Because adult studies have not controlled for the weekly duration of dialysis, we fixed the total treatment time at 12 h a week of dialysis during two 3-month study periods; only frequency varied from 5 to 3 days per week between study periods. RESULTS Eight children (median age 16.7 years) consented at three children's hospitals. The prespecified primary composite outcome was a sustained 10% decrease in systolic blood pressure and/or a decrease in antihypertensive medications relative to each study period's baseline. Among the six patients completing both study periods, five (83.3%) experienced the primary outcome during HD performed 5 days per week but not 3 days per week; one of the six (16.7%) achieved that outcome during 3-day but not 5-day (p = 0.22) per week HD. During 5-day HD, all patients had significantly more treatments during which their pre-HD systolic (p = 0.01) or diastolic (p = 0.01) blood pressure was 10% lower than baseline. CONCLUSIONS We observed that more frequent HD sessions per week was feasible and associated with improved blood pressure control, but barriers to changing thrice-weekly standard of care include financial reimbursement and the time demands associated with more frequent treatments.
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Affiliation(s)
- Benjamin L. Laskin
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Canada
| | - Joshua P. Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Susan L. Furth
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Tom Kimball
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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35
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Brady TM, Townsend K, Schneider MF, Cox C, Kimball T, Madueme P, Warady B, Furth S, Mitsnefes M. Cystatin C and Cardiac Measures in Children and Adolescents With CKD. Am J Kidney Dis 2016; 69:247-256. [PMID: 27856090 DOI: 10.1053/j.ajkd.2016.08.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/17/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is highly prevalent among children with chronic kidney disease (CKD). Cystatin C is an established marker of kidney function and an emerging biomarker for CVD events. We quantified the relationship between cystatin C level and cardiac structure and function over time among children with CKD and assessed whether cystatin C level and diastolic function retained an association after accounting for kidney function. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 678 children and adolescents with mild to moderate CKD enrolled in the CKD in Children (CKiD) Study with 1,228 echocardiographically obtained cardiac structure and function measurements. PREDICTOR Serum cystatin C (mg/L) measured annually. OUTCOMES Cardiac structure (left ventricular mass index [g/m2.7]) and cardiac function (shortening fraction; E/A, E'/A', E/E' ratios) measured every other year. MEASUREMENTS Demographics and anthropometrics, measured glomerular filtration rate (mGFR), heart rate, blood pressure, hemoglobin z score, serum albumin level, and calcium-phosphorus product. RESULTS Independent of time, each 1-mg/L increase in cystatin C level was independently associated with a concurrent 7.7% (95% CI, 5.3%-10.0%) increase in left ventricular mass index, a -4.7% (95% CI, -7.0% to -2.4%) change in E/A ratio, a -6.6% (95% CI, -9.0% to -4.2%) change in E'/A' ratio, and a 2.5% (95% CI, 0.3%-4.7%) increase in E/E' ratio. mGFR was also independently associated with E'/A' ratio. When cystatin C level and mGFR were included in the same model, cystatin C level remained independently associated with E'/A' ratio, whereas mGFR was not. LIMITATIONS 24% of the cohort was missing data for outcomes of interest or measurements; study population includes only children and adolescents with mild to moderate CKD. CONCLUSIONS In this study of children and adolescents with mild to moderate CKD, cystatin C level was independently associated with cardiac structure and diastolic function. Cystatin C level remained able to predict diastolic function decline via E'/A' ratio even after adjusting for mGFR, suggesting that cystatin C level may have an independent role in CVD risk stratification among children and adolescents with CKD.
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Affiliation(s)
- Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Kelly Townsend
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas Kimball
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Peace Madueme
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO
| | - Susan Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Ruebner RL, Ng D, Mitsnefes M, Foster BJ, Meyers K, Warady B, Furth SL. Cardiovascular Disease Risk Factors and Left Ventricular Hypertrophy in Girls and Boys With CKD. Clin J Am Soc Nephrol 2016; 11:1962-1968. [PMID: 27630183 PMCID: PMC5108185 DOI: 10.2215/cjn.01270216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/22/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Prior studies suggested that women with CKD have higher risk for cardiovascular disease (CVD) and mortality than men, although putative mechanisms for this higher risk have not been identified. We assessed sex differences in (1) CVD risk factors and left ventricular hypertrophy (LVH), and (2) the relationship of left ventricular mass (LVM) with different measures of body size in children with CKD. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS The study population comprised 681 children with CKD from the Chronic Kidney Disease in Children cohort, contributing 1330 visits. CVD risk factors were compared cross-sectionally by sex. LVH was defined as LVM/height2.7 >95th percentile and LVM relative to estimated lean body mass (eLBM) >95th percentile for age and sex. Differences in LVM by sex were assessed by adjusting for age, weight, height, and eLBM using bivariate and multivariate regression models. RESULTS Girls were less likely to have uncontrolled hypertension (26% versus 38%, P=0.001), had lower diastolic BP z-scores (+0.3 versus +0.6, P=0.001), and had lower prevalence of high triglycerides (38% versus 47%, P=0.03) compared with boys. When LVH was defined by LVM indexed to height, girls had higher prevalence of LVH (16% versus 9%, P=0.01); when LVH was defined by LVM relative to eLBM, prevalence of LVH was similar between girls and boys (18% versus 17%, P=0.92). In regression models adjusting for eLBM, no sex differences in LVM were observed. CONCLUSIONS Despite lack of increased prevalence of CVD risk factors, indexing LVM to height showed a higher proportion of LVH among girls, while estimates of LVH based on eLBM showed no sex differences. Indexing LVM to eLBM may be an alternative to height indexing in children with CKD.
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Affiliation(s)
| | - Derek Ng
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Mark Mitsnefes
- Division of Nephrology, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Bethany J. Foster
- Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Kevin Meyers
- Division of Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, and
| | - Bradley Warady
- Division of Nephrology, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
| | - Susan L. Furth
- Division of Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, and
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Muntner P, Becker RC, Calhoun D, Chen D, Cowley AW, Flynn JT, Grobe JL, Kidambi S, Kotchen TA, Lackland DT, Leslie KK, Li Y, Liang M, Lloyd A, Mattson DL, Mendizabal B, Mitsnefes M, Nair A, Pierce GL, Pollock JS, Safford MM, Santillan MK, Sigmund CD, Thomas SJ, Urbina EM. Introduction to the American Heart Association's Hypertension Strategically Focused Research Network. Hypertension 2016; 67:674-80. [PMID: 26902490 DOI: 10.1161/hypertensionaha.115.06433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Muntner
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.).
| | - Richard C Becker
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - David Calhoun
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Daian Chen
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Allen W Cowley
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Joseph T Flynn
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Justin L Grobe
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Srividya Kidambi
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Theodore A Kotchen
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Daniel T Lackland
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Kimberly K Leslie
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Yingchuan Li
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Mingyu Liang
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Augusta Lloyd
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - David L Mattson
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Brenda Mendizabal
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Mark Mitsnefes
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Anand Nair
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Gary L Pierce
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Jennifer S Pollock
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Monika M Safford
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Mark K Santillan
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Curt D Sigmund
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Stephen J Thomas
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
| | - Elaine M Urbina
- From the Department of Epidemiology (P.M., S.J.T.), and Divisions of Preventive Medicine (M.M.S.), Nephrology (D.C., J.S.P.), and Cardiology (D.C.), Department of Medicine, University of Alabama at Birmingham; Department of Physiology (M.L., A.W.C., D.L.M., Y.L.), and Division of Endocrinology, Department of Medicine (T.K., S.K.), Medical College of Wisconsin, Milwaukee; Departments of Pharmacology (C.D.S., J.L.G., A.N.), Health and Human Physiology (G.L.P.), and Obstetrics and Gynecology (K.K.L., M.K.S.), University of Iowa, Iowa City; Department of Pediatrics, Cincinnati Children's Hospital, OH (E.U., M.M., B.M.); Department of Medicine, University of Cincinnati, OH (R.C.B.); Division of Nephrology, Department of Medicine, Seattle Children's Hospital, WA (J.T.F.); American Heart Association, Dallas, TX (A.L.); and Department of Public Health Sciences, Medical University of South Carolina, Charleston (D.T.L.)
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Foster BJ, Khoury PR, Kimball TR, Mackie AS, Mitsnefes M. New Reference Centiles for Left Ventricular Mass Relative to Lean Body Mass in Children. J Am Soc Echocardiogr 2016; 29:441-447.e2. [PMID: 26850680 DOI: 10.1016/j.echo.2015.12.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Echocardiographic measurement of left ventricular (LV) mass is routinely performed in pediatric patients with elevated cardiovascular risk. The complex relationship between heart growth and body growth in children requires normalization of LV mass to determine its appropriateness relative to body size. LV mass is strongly determined by lean body mass (LBM). Using new LBM predictive equations, the investigators generated sex-specific LV mass-for-LBM centile curves for children 5 to 18 years of age. METHODS This retrospective study used M-mode echocardiographic data collected from 1995 through 2003 from 939 boys and 771 girls between 5 and 18 years of age (body mass index < 85th percentile for sex and age) to create smoothed sex-specific LV mass-for-LBM reference centile curves using the Lamda Mu Sigma method. The newly developed reference centiles were applied to children with essential hypertension and with chronic kidney disease, groups known to be at high risk for LV hypertrophy (LVH). The identification of LVH using two different normalization approaches was compared: LV mass-for-LBM and LV mass index-for-age percentiles. RESULTS Among 231 children at risk for LVH, on average, relative LV mass was higher using the LV mass index-for-age percentile method than the LV mass-for-LBM percentile method. LVH was more likely to be diagnosed among overweight children and less likely among thin children. CONCLUSIONS This study provides new LV mass reference centiles expressing LV mass relative to LBM, the strongest determinant of LV mass. These reference centiles may allow more accurate stratification of cardiovascular risk in children.
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Affiliation(s)
- Bethany J Foster
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
| | - Philip R Khoury
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas R Kimball
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew S Mackie
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Woroniecki RP, Ng DK, Limou S, Winkler CA, Reidy KJ, Mitsnefes M, Sampson MG, Wong CS, Warady BA, Furth SL, Kopp JB, Kaskel FJ. Renal and Cardiovascular Morbidities Associated with APOL1 Status among African-American and Non-African-American Children with Focal Segmental Glomerulosclerosis. Front Pediatr 2016; 4:122. [PMID: 27900314 PMCID: PMC5110572 DOI: 10.3389/fped.2016.00122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/28/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES African-American (AA) children with focal segmental glomerulosclerosis (FSGS) have later onset disease that progresses more rapidly than in non-AA children. It is unclear how APOL1 genotypes contribute to kidney disease risk, progression, and cardiovascular morbidity in children. DESIGN SETTING PARTICIPANTS AND MEASUREMENTS We examined the prevalence of APOL1 genotypes and associated cardiovascular phenotypes among children with FSGS in the Chronic Kidney Disease in Children (CKiD) study; an ongoing multicenter prospective cohort study of children aged 1-16 years with mild to moderate kidney disease. RESULTS A total of 140 AA children in the CKiD study were genotyped. High risk (HR) APOL1 genotypes were present in 24% of AA children (33/140) and were associated with FSGS, p < 0.001. FSGS was the most common cause of glomerular disease in children with HR APOL1 (89%; 25/28). Of 32 AA children with FSGS, 25 (78%) had HR APOL1. Compared to children with low risk APOL1 and FSGS (comprising 36 non-AA and 7 AA), children with HR APOL1 developed FSGS at a later age, 12.0 (IQR: 9.5, 12.5) vs. 5.5 (2.5, 11.5) years, p = 0.004, had a higher prevalence of uncontrolled hypertension (52 vs. 33%, p = 0.13), left ventricular hypertrophy (LVH) (53 vs. 12%, p < 0.01), C-reactive protein > 3 mg/l (33 vs. 15%, p = 0.12), and obesity (48 vs. 19%, p = 0.01). There were no differences in glomerular filtration rate, hemoglobin, iPTH, or calcium-phosphate product. CONCLUSION AA children with HR APOL1 genotype and FSGS have increase prevalence of obesity and LVH despite a later age of FSGS onset, while adjusting for socioeconomic status. Treatment of obesity may be an important component of chronic kidney disease and LVH management in this population.
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Affiliation(s)
| | - Derek K Ng
- Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Sophie Limou
- Basic Research Laboratory, Frederick National Laboratory, NCI, NIH, Leidos Biomedical , Frederick, MD , USA
| | - Cheryl A Winkler
- Basic Research Laboratory, Frederick National Laboratory, NCI, NIH, Leidos Biomedical , Frederick, MD , USA
| | - Kimberly J Reidy
- Pediatric Nephrology, Children's Hospital at Montefiore , Bronx, NY , USA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | - Matthew G Sampson
- Division of Pediatric Nephrology, University of Michigan School of Medicine , Ann Arbor, MI , USA
| | - Craig S Wong
- Pediatric Nephrology, University of New Mexico , Albuquerque, NM , USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital , Kansas City, MO , USA
| | | | | | - Frederick J Kaskel
- Pediatric Nephrology, Children's Hospital at Montefiore , Bronx, NY , USA
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Warady BA, Abraham AG, Schwartz GJ, Wong CS, Muñoz A, Betoko A, Mitsnefes M, Kaskel F, Greenbaum LA, Mak RH, Flynn J, Moxey-Mims MM, Furth S. Predictors of Rapid Progression of Glomerular and Nonglomerular Kidney Disease in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort. Am J Kidney Dis 2015; 65:878-88. [PMID: 25799137 PMCID: PMC4578873 DOI: 10.1053/j.ajkd.2015.01.008] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/04/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few studies have prospectively evaluated the progression of chronic kidney disease (CKD) in children and adolescents, as well as factors associated with progression. STUDY DESIGN Prospective multicenter observational cohort study. SETTING & PARTICIPANTS 496 children and adolescents with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study. PREDICTORS Proteinuria, hypoalbuminemia, blood pressure, dyslipidemia, and anemia. OUTCOMES Parametric failure-time models were used to characterize adjusted associations between baseline levels and changes in predictors and time to a composite event of renal replacement therapy or 50% decline in glomerular filtration rate (GFR). RESULTS 398 patients had nonglomerular disease and 98 had glomerular disease; of these, 29% and 41%, respectively, progressed to the composite event after median follow-ups of 5.2 and 3.7 years, respectively. Demographic and clinical characteristics and outcomes differed substantially according to the underlying diagnosis; hence, risk factors for progression were assessed in stratified analyses, and formal interactions by diagnosis were performed. Among patients with nonglomerular disease and after adjusting for baseline GFR, times to the composite event were significantly shorter with urinary protein-creatinine ratio > 2mg/mg, hypoalbuminemia, elevated blood pressure, dyslipidemia, male sex, and anemia, by 79%, 69%, 38%, 40%, 38%, and 45%, respectively. Among patients with glomerular disease, urinary protein-creatinine ratio >2mg/mg, hypoalbuminemia, and elevated blood pressure were associated with significantly reduced times to the composite event by 94%, 71%, and 67%, respectively. Variables expressing change in patient clinical status over the initial year of the study contributed significantly to the model, which was cross-validated internally. LIMITATIONS Small number of events in glomerular patients and use of internal cross-validation. CONCLUSIONS Characterization and modeling of risk factors for CKD progression can be used to predict the extent to which these factors, either alone or in combination, would shorten the time to renal replacement therapy or 50% decline in GFR in children with CKD.
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Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO.
| | | | | | - Craig S Wong
- University of New Mexico/Children's Hospital, Albuquerque, NM
| | - Alvaro Muñoz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Aisha Betoko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Robert H Mak
- University of California at San Diego, La Jolla, CA
| | | | - Marva M Moxey-Mims
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Susan Furth
- The Children's Hospital of Philadelphia, Philadelphia, PA
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Affiliation(s)
- Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Nehus E, Furth S, Warady B, Mitsnefes M. Correlates of leptin in children with chronic kidney disease. J Pediatr 2014; 165:825-9. [PMID: 25066063 PMCID: PMC4177449 DOI: 10.1016/j.jpeds.2014.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/27/2014] [Accepted: 06/10/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the relative associations of renal function, obesity, and inflammation with serum leptin levels in children with chronic kidney disease (CKD). STUDY DESIGN This was a cross-sectional analysis of 317 children from the Chronic Kidney Disease in Children study, a large cohort of pediatric patients with stage II-IV CKD. Linear regression modeling was used to evaluate the association of serum leptin level with glomerular filtration rate calculated using the plasma iohexol disappearance curve, demographics, body mass index (BMI), and cardiovascular risk factors, including inflammatory cytokines, insulin resistance, and serum lipid levels. RESULTS In univariate analyses, elevated serum leptin level was significantly associated with increased BMI, older age, and female sex (P < .001 for all). Leptin level also correlated positively with serum triglycerides and insulin resistance (P < .001) and negatively with serum high-density lipoprotein cholesterol (P = .002). Leptin level was not associated with glomerular filtration rate calculated using the plasma iohexol disappearance curve or inflammatory cytokines. In multivariate analysis, BMI, age, female sex, and serum triglyceride levels were significantly associated with serum leptin level. CONCLUSION Increased leptin production was associated with female sex, older age, and adiposity in children with mild to moderate CKD. Renal function was not associated with serum leptin level, indicating that decreased clearance does not contribute to elevated leptin levels.
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Affiliation(s)
- Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Susan Furth
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bradley Warady
- Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Barletta GM, Flynn J, Mitsnefes M, Samuels J, Friedman LA, Ng D, Cox C, Poffenbarger T, Warady B, Furth S. Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study. Pediatr Nephrol 2014; 29:1059-65. [PMID: 24488505 PMCID: PMC4072494 DOI: 10.1007/s00467-013-2737-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/04/2013] [Accepted: 12/16/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Autonomic nervous system dysfunction and sympathetic nervous system over-activity play important roles in the development of hypertension associated with chronic kidney disease (CKD). In adults, increased blood pressure variability (BPV) appears to be directly related to sympathetic over-activity with increased risk of end-organ damage and cardiovascular events. Decreased heart rate variability (HRV) has been observed in adults with CKD, and is an independent predictor of mortality. METHODS The purpose of this study was to evaluate BPV and HRV in pediatric patients enrolled in the Chronic Kidney Disease in Children Study. Ambulatory blood pressure monitoring data were available for analysis of 215 person-visits from 144 children that were not receiving antihypertensive medications. RESULTS BPV and HRV were determined by standard deviation and coefficient of variation for heart rate and systolic and diastolic blood pressure for each patient averaged for wake/sleep periods during 24-h monitoring. Uniformly lower values were displayed during sleep versus wake periods: BPV was 20 % lower during sleep (p < 0.001) and HRV was 30 % lower during sleep (p < 0.001). A significant increase in systolic BPV was observed in hypertensive children compared to children with normal blood pressure (6.9 %, p = 0.009). Increased diastolic BPV was detected among hypertensive children during sleep period compared to children with normal blood pressure (11.5 %, p = 0.008). There was a significant decrease in HRV in hypertensive compared to normotensive children (-8.2 %, p = 0.006). CONCLUSIONS These findings are similar to those in adult patients and may underscore childhood origin and natural progression of adverse cardiovascular outcomes in adults with CKD.
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Affiliation(s)
- Gina-Marie Barletta
- Pediatric Nephrology, Dialysis and Transplantation, Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA,
| | | | | | | | | | - Derek Ng
- John’s Hopkins, Baltimore, MD, USA
| | | | | | | | - Susan Furth
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, Zachariah JP, Urbina EM. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 2014; 63:1116-35. [PMID: 24591341 PMCID: PMC4146525 DOI: 10.1161/hyp.0000000000000007] [Citation(s) in RCA: 388] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitsnefes M, Scherer PE, Friedman LA, Gordillo R, Furth S, Warady BA. Ceramides and cardiac function in children with chronic kidney disease. Pediatr Nephrol 2014; 29:415-22. [PMID: 24389650 PMCID: PMC4068150 DOI: 10.1007/s00467-013-2642-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased incidence of cardiac dysfunction. Recent animal studies have demonstrated that elevated levels of ceramides cause dilated lipotoxic cardiomyopathy. We hypothesized ceramides are increased in children with CKD and associated with abnormal cardiac structure and function. METHODS Ceramide levels were determined in 93 children aged 1-16 years enrolled in the Chronic Kidney Disease in Children (CKiD) study and compared to levels from 24 healthy controls. Complete demographic, clinical, and laboratory information, and ceramide measurements were analyzed cross-sectionally. Echocardiography was performed to determine cardiac structure and function. RESULTS Very long-chain C24:0 ceramides were the most abundant species in both control (56 %) and CKD subjects (55 %), followed by C24:1 (controls 19 %, CKD 23 %) and C22:0 (controls 19 %, CKD 13 %). Total serum ceramide levels were significantly higher in CKD children versus controls (p < 0.001). Ceramide metabolites lactosylceramide, C24:0L, and C16:0L were significantly higher in CKD subjects than controls (p < 0.001). The proportion of C24:0L was dramatically higher in CKD (59 %) versus control (17 %) subjects (p < 0.001). In adjusted multivariate analyses, higher log10C24:0L and log10C16:0L were significant predictors of lower shortening fraction and mid-wall shortening. CONCLUSIONS Ceramide levels are increased in children with CKD. Our study identified lactosylceramides as an independent predictor of lower systolic function in these children.
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MESH Headings
- Adolescent
- Biomarkers/blood
- Case-Control Studies
- Ceramides/blood
- Child
- Child, Preschool
- Echocardiography, Doppler
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Infant
- Lactosylceramides/blood
- Linear Models
- Male
- Multivariate Analysis
- Myocardial Contraction
- North America
- Pilot Projects
- Prospective Studies
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/diagnosis
- Risk Factors
- Up-Regulation
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC: 7022, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA,
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Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, Harmon CM, Courcoulas A, Horlick M, Xanthakos SA, Dolan L, Mitsnefes M, Barnett SJ, Buncher R. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 2014; 168:47-53. [PMID: 24189578 PMCID: PMC4060250 DOI: 10.1001/jamapediatrics.2013.4296] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Severe obesity in childhood is a major health problem with few effective treatments. Weight-loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally invasive procedures. OBJECTIVE To assess the preoperative clinical characteristics and perioperative safety outcomes of severely obese adolescents undergoing WLS. DESIGN, SETTING, AND PARTICIPANTS This prospective, multisite observational study enrolled patients from February 28, 2007, through December 30, 2011. Consecutive patients aged 19 years or younger who were approved to undergo WLS (n = 277) were offered enrollment into the study at 5 academic referral centers in the United States; 13 declined participation and 22 did not undergo surgery after enrollment, thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. MAIN OUTCOMES AND MEASURES This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Reoperations and hospital readmissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. RESULTS The mean (SD) age of participants was 17.1 (1.6) years and the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 50.5. Fifty-one percent demonstrated 4 or more major comorbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of patients, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg, reoperation) were seen in 19 patients (8%). Minor complications (eg, readmission for dehydration) were noted in 36 patients (15%). All reoperations and 85% of readmissions were related to WLS. CONCLUSIONS AND RELEVANCE In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed a favorable short-term complication profile, supporting the early postoperative safety of WLS in select adolescents. Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00474318.
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Affiliation(s)
- Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary L Brandt
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | | | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Larry Dolan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sean J Barnett
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Inge TH, King WC, Jenkins TM, Courcoulas AP, Mitsnefes M, Flum DR, Wolfe BM, Pomp A, Dakin GF, Khandelwal S, Zeller MH, Horlick M, Pender JR, Chen JY, Daniels SR. The effect of obesity in adolescence on adult health status. Pediatrics 2013; 132:1098-104. [PMID: 24249816 PMCID: PMC3838536 DOI: 10.1542/peds.2013-2185] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that adolescent obesity would be associated with greater risks of adverse health in severely obese adults. METHODS Before weight loss surgery, adult participants in the Longitudinal Assessment of Bariatric Surgery-2 underwent detailed anthropometric and comorbidity assessment. Weight status at age 18 was retrospectively determined. Participants who were ≥80% certain of recalled height and weight at age 18 (1502 of 2308) were included. Log binomial regression was used to evaluate whether weight status at age 18 was independently associated with risk of comorbid conditions at time of surgery controlling for potential confounders. RESULTS Median age and adult body mass index (BMI) were 47 years and 46, respectively. At age 18, 42% of subjects were healthy weight, 29% overweight, 16% class 1 obese, and 13% class ≥2 obese. Compared with healthy weight at age 18, class ≥2 obesity at age 18 independently increased the risk of lower-extremity venous edema with skin manifestations by 435% (P < .0001), severe walking limitation by 321% (P < .0001), abnormal kidney function by 302% (P < .0001), polycystic ovary syndrome by 74% (P = .03), asthma by 48% (P = .01), diabetes by 42% (P < .01), obstructive sleep apnea by 25% (P < .01), and hypertension (by varying degrees based on age and gender). Conversely, the associated risk of hyperlipidemia was reduced by 61% (P < .01). CONCLUSIONS Severe obesity at age 18 was independently associated with increased risk of several comorbid conditions in adults undergoing bariatric surgery.
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Affiliation(s)
- Thomas H. Inge
- Department of Pediatrics and Pediatric Surgery, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Wendy C. King
- Department of Epidemiology, School of Public Health and
| | - Todd M. Jenkins
- Department of Pediatrics and Pediatric Surgery, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Anita P. Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark Mitsnefes
- Department of Pediatrics and Pediatric Surgery, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - David R. Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | - Bruce M. Wolfe
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Greg F. Dakin
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | | | - Meg H. Zeller
- Department of Pediatrics and Pediatric Surgery, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Mary Horlick
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - John R. Pender
- Department of Surgery, East Carolina University, Greenville, North Carolina; and
| | - Jia-Yuh Chen
- Department of Epidemiology, School of Public Health and
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Kupferman JC, Aronson Friedman L, Cox C, Flynn J, Furth S, Warady B, Mitsnefes M. BP control and left ventricular hypertrophy regression in children with CKD. J Am Soc Nephrol 2013; 25:167-74. [PMID: 24071004 DOI: 10.1681/asn.2012121197] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In adult patients with CKD, hypertension is linked to the development of left ventricular hypertrophy, but whether this association exists in children with CKD has not been determined conclusively. To assess the relationship between BP and left ventricular hypertrophy, we prospectively analyzed data from the Chronic Kidney Disease in Children cohort. In total, 478 subjects were enrolled, and 435, 321, and 142 subjects remained enrolled at years 1, 3, and 5, respectively. Echocardiograms were obtained 1 year after study entry and then every 2 years; BP was measured annually. A linear mixed model was used to assess the effect of BP on left ventricular mass index, which was measured at three different visits, and a mixed logistic model was used to assess left ventricular hypertrophy. These models were part of a joint longitudinal and survival model to adjust for informative dropout. Predictors of left ventricular mass index included systolic BP, anemia, and use of antihypertensive medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Predictors of left ventricular hypertrophy included systolic BP, female sex, anemia, and use of other antihypertensive medications. Over 4 years, the adjusted prevalence of left ventricular hypertrophy decreased from 15.3% to 12.6% in a systolic BP model and from 15.1% to 12.6% in a diastolic BP model. These results indicate that a decline in BP may predict a decline in left ventricular hypertrophy in children with CKD and suggest additional factors that warrant additional investigation as predictors of left ventricular hypertrophy in these patients.
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Affiliation(s)
- Juan C Kupferman
- Division of Pediatric Nephrology and Hypertension, Maimonides Medical Center, Brooklyn, New York
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50
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Omoloja A, Jerry-Fluker J, Ng DK, Abraham AG, Furth S, Warady BA, Mitsnefes M. Secondhand smoke exposure is associated with proteinuria in children with chronic kidney disease. Pediatr Nephrol 2013; 28:1243-51. [PMID: 23584848 PMCID: PMC3703840 DOI: 10.1007/s00467-013-2456-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND In adults with chronic kidney disease (CKD), cigarette smoking is associated with an increased risk for CKD progression and transplant failure. In children, secondhand smoke (SHS) exposure has been associated with elevated blood pressure. There are no studies on the prevalence and effect of SHS exposure in CKD. METHODS Subjects were enrolled in the Chronic Kidney Disease in Children (CKiD) Study, an observational cohort of 366 children aged 1 to 16 years with CKD. Secondhand smoke exposure was obtained via questionnaire. SHS exposure was also determined based on urine cotinine (Ucot) measurements (1 ng/mL ≤ Ucot < 75 ng/mL). The cross-sectional association of SHS exposure with proteinuria was assessed. RESULTS Using Ucot, 22 % of subjects were exposed to SHS. SHS exposure was significantly associated with lower maternal education and African American race, and a greater prevalence of nephrotic range proteinuria and left ventricular hypertrophy. In a multivariate model (including sex, age, race, maternal education, income level, private insurance status, abnormal birth history and CKD diagnosis), the prevalence odds of nephrotic range proteinuria was 2.64, (95 % confidence interval 1.08, 6.42) higher in children exposed to SHS compared to those unexposed. CONCLUSIONS In our cohort of children with CKD, SHS exposure was common (22 %) and independently associated with nephrotic range proteinuria. Exposure to SHS may be an important factor to consider in CKD progression.
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Affiliation(s)
- Abiodun Omoloja
- Department of Pediatrics, Wright State University, One Children's Plaza, Dayton, OH 45404, USA.
| | - Judith Jerry-Fluker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan Furth
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Mark Mitsnefes
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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