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Assessment of the cardiovascular system in pediatric chronic kidney disease: a pilot study

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Abstract

Long-term survival of children and adolescents with chronic kidney disease (CKD) is mainly limited by cardiovascular disease. Pediatric CKD patients (n = 26) on conservative treatment, dialysis and after renal transplantation were compared with healthy controls (n = 24) with respect to cardiovascular status. Mean baseline diameter of the brachial artery was significantly higher, and mean flow-mediated vasodilation (FMD) was significantly reduced, in CKD patients. CKD patients showed significantly increased left ventricular mass index, blood pressure (BP) values and age-related values of mean carotid intima-media thickness [intima-media thickness–standard deviation score (IMT-SDS)] compared with those of controls. Approximately 60% of patients presented with impaired FMD (≤ 5.79%), which was significantly associated with intima-media thickening, although only three patients (12%) presented with both, impaired FMD and increased age-related IMT. The latter was significantly associated with higher values for day-time BP. In contrast, duration and degree of CKD, mode of renal replacement therapy, homocysteine levels and concomitant medication showed no association with cardiovascular status. The majority of our pediatric CKD patients showed reduced endothelial function, which may have preceded the development of carotid arteriopathy. Therefore, routine assessment of FMD may be a useful tool to identify CKD patients at risk of progressive cardiovascular morbidity.

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Abbreviations

ABPM:

ambulatory blood pressure monitoring

BMI:

body mass index

BP:

blood pressure

CKD:

chronic kidney disease

CrP:

C-reactive protein

ESRD:

end-stage renal disease

FMD:

flow-mediated vasodilation

GFR:

glomerular filtration rate

IMT:

intima-media thickness

IMT-SDS:

intima-media thickness-standard deviation score

LVH:

left ventricular hypertrophy

LVM:

left ventricular mass

References

  1. Briese S, Wiesner S, Will JC, Lembcke A, Opgen-Rhein B, Nissel R, Wernecke KD, Andreae J, Haffner D, Querfeld U (2006) Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease—impact of calcium and vitamin D therapy. Nephrol Dial Transplant 21:1906–1914

    Article  CAS  Google Scholar 

  2. Mitsnefes MM (2008) Cardiovascular complications of pediatric chronic kidney disease. Pediatr Nephrol 23:27–39

    Article  Google Scholar 

  3. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105

    Article  Google Scholar 

  4. Parekh RS, Carroll CE, Wolfe RA, Port FK (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197

    CAS  Google Scholar 

  5. Mitsnefes MM, Barletta GM, Dresner IG, Chand DH, Geary D, Lin JJ, Patel H (2006) Severe cardiac hypertrophy and long-term dialysis: the Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 21:1167–1170

    Article  Google Scholar 

  6. Mitsnefes MM, Daniels SR, Schwartz SM, Meyer RA, Khoury P, Strife CF (2000) Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr Nephrol 14:898–902

    Article  CAS  Google Scholar 

  7. Kari JA, Donald AE, Vallance DT, Bruckdorfer KR, Leone A, Mullen MJ, Bunce T, Dorado B, Deanfield JE, Rees L (1997) Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int 52:468–472

    Article  CAS  Google Scholar 

  8. Lilien MR, Stroes ES, Op’t Roodt J, de Jongh S, Schroder CH, Koomans HA (2003) Vascular function in children after renal transplantation. Am J Kidney Dis 41:684–691

    Article  Google Scholar 

  9. London GM, Pannier B, Agharazii M, Guerin AP, Verbeke FH, Marchais SJ (2004) Forearm reactive hyperemia and mortality in end-stage renal disease. Kidney Int 65:700–704

    Article  Google Scholar 

  10. Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500

    Article  Google Scholar 

  11. Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 16:2796–2803

    Article  CAS  Google Scholar 

  12. Lachin JM (2000) Biostatistical methods. The assessment of relative risk. Wiley-VCH, Weinheim, Berlin

    Book  Google Scholar 

  13. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    Article  CAS  Google Scholar 

  14. Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, Menner K, Müller G, Müller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Ziegler A, Hebebrand J (2001) Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 149:807–818

    Article  Google Scholar 

  15. Prader A, Largo RH, Molinari L, Issler C (1989) Physical growth of Swiss children from birth to 20 years of age. First Zurich longitudinal study of growth and development. Helv Paediatr Acta Suppl 52:1–125

    CAS  PubMed  Google Scholar 

  16. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the national high blood pressure education program. Pediatrics 98:649–658

    Google Scholar 

  17. Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319

    Article  CAS  Google Scholar 

  18. Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184

    Article  CAS  Google Scholar 

  19. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007

    Article  Google Scholar 

  20. Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083

    Article  CAS  Google Scholar 

  21. Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618

    Article  CAS  Google Scholar 

  22. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062

    Article  Google Scholar 

  23. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, Alderman MH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260

    Article  Google Scholar 

  24. Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, Wawer ZT, Grenda R (2006) Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819

    Article  Google Scholar 

  25. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 39:257–265

    Article  Google Scholar 

  26. Meyer AA, Kundt G, Steiner M, Schuff-Werner P, Kienast W (2006) Impaired flow-mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: the impact of cardiovascular risk factors. Pediatrics 117:1560–1567

    Article  Google Scholar 

  27. Jourdan C, Wühl E, Litwin M, Fahr K, Trelewicz J, Jobs K, Schenk JP, Grenda R, Mehls O, Tröger J, Schaefer F (2005) Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 23:1707–1715

    Article  CAS  Google Scholar 

  28. Caglar K, Yilmaz MI, Saglam M, Cakir E, Kilic S, Eyileten T, Sonmez A, Oguz Y, Oner K, Ors F, Vural A, Yenicesu M (2007) Endothelial dysfunction and fetuin A levels before and after kidney transplantation. Transplantation 83:392–397

    Article  CAS  Google Scholar 

  29. Mitsnefes MM, Kimball TR, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2004) Abnormal carotid artery structure and function in children and adolescents with successful renal transplantation. Circulation 110:97–101

    Article  Google Scholar 

  30. Nayir A, Bilge I, Kilicaslan I, Ander H, Emre S, Sirin A (2001) Arterial changes in paediatric haemodialysis patients undergoing renal transplantation. Nephrol Dial Transplant 16:2041–2047

    Article  CAS  Google Scholar 

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Author notes

  1. Andreas Alexander Meyer

    Present address: Pediatric Outpatient Clinic, Wilhelmshaven, Germany

Authors and Affiliations

  1. Department of Pediatrics, University of Rostock, Rostock, Germany

    Jutta Muscheites, Erdmute Drueckler, Marianne Wigger, Dagmar-Christiane Fischer & Dieter Haffner

  2. Department of Pediatrics, University Hospital, Rembrandtstr. 16/17, 18057, Rostock, Germany

    Jutta Muscheites

  3. Division of Pediatric Cardiology and Intensive Care, University of Rostock, Rostock, Germany

    Andreas Alexander Meyer & Wolfgang Kienast

  4. Institute of Medical Informatics and Biometry, University of Rostock, Rostock, Germany

    Guenther Kundt

Authors
  1. Jutta Muscheites
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Correspondence to Jutta Muscheites.

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Muscheites, J., Meyer, A.A., Drueckler, E. et al. Assessment of the cardiovascular system in pediatric chronic kidney disease: a pilot study. Pediatr Nephrol 23, 2233–2239 (2008). https://doi.org/10.1007/s00467-008-0906-y

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  • DOI: https://doi.org/10.1007/s00467-008-0906-y

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