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Coronary artery calcifications in children with end-stage renal disease

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Abstract

Coronary artery calcification (CAC) is common in adults with end-stage renal disease (ESRD), but little is known about the prevalence and the extent of it in children. We used multidetector spiral computed tomography (MDCT), echocardiography, and carotid and brachial high-resolution ultrasonography to screen for the presence and predisposing factors of CAC in 53 children with ESRD [15 hemodialysis (HD) patients, 24 peritoneal dialysis (PD) patients, and 14 renal transplant (rTx) recipients]. CAC was present in 15% of patients (three HD patients, three PD patients, and two rTx). The mean age of the patients with CAC was 16.4 years (range: 11.0–21.2 years), and their median CAC score was 101.3, ranging from 8.5 to 4,322 according to the Agatston method. The patients with CAC had longer duration of total dialysis (P=0.005), had higher time-integrated serum phosphorus (P<0.001), calcium-phosphate (CaxP) product (P=0.012), intact parathyroid hormone (P=0.010), vitamin B12 levels (P=0.010), the amount of cumulative calcium-containing oral phosphate binders (OBPs) (P<0.001), and calcitriol intake (P<0.001), and had lower serum hemoglobin level (P=0.014). Interventricular septum systolic thickness (P=0.033) was significantly higher, relative wall thickness (P=0.062) tended to be higher, and flow-mediated endothelium-dependent dilatations (P=0.071) were lower without reaching statistically significant levels in those with CAC. A stepwise logistic regression analysis revealed that serum phosphorus (P=0.018) and the cumulative exposure to calcium-containing OPBs (P=0.016) were the most significant independent predictors in the development of CAC. These results indicate that even adolescents and children with ESRD may have coronary calcifications. We concluded that impaired divalent ion metabolism is the main factor in the formation of CAC in this age group.

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Acknowledgements

The authors would like to thank Franz Schaefer, MD, for his careful reading and review of the manuscript. Financial support for this study was obtained from the Turkish Pediatric Association, and statistical analysis was supported by the Turkish Society of Nephrology Istanbul Branch. This study has been presented in part at the 39th Annual Meeting of the European Society for Paediatric Nephrology (2005) and published in abstract form in Pediatric Nephrology 20:C28.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Istanbul University, Cerrahpasa Medical Faculty, 34303 Cerrahpasa, Istanbul, Turkey

    Mahmut Civilibal, Salim Caliskan, Lale Sever, Cengiz Candan, Nur Canpolat, Ozgur Kasapcopur & Nil Arisoy

  2. Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey

    Ibrahim Adaletli & Sebuh Kuruoglu

  3. Department of Internal Medicine, Division of Cardiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey

    Huseyin Oflaz

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  1. Mahmut Civilibal
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Correspondence to Mahmut Civilibal.

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Civilibal, M., Caliskan, S., Adaletli, I. et al. Coronary artery calcifications in children with end-stage renal disease. Pediatr Nephrol 21, 1426–1433 (2006). https://doi.org/10.1007/s00467-006-0159-6

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  • DOI: https://doi.org/10.1007/s00467-006-0159-6

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