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  • Review Article
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Cardiovascular disease in children with CKD or ESRD

Nature Reviews Nephrology volume 5, pages 229–235 (2009)Cite this article

Abstract

Cardiovascular disease accounts for 40% of all deaths among pediatric patients with end-stage renal disease (ESRD). ESRD has a particularly large influence on the cardiovascular system in children, as indicated by the more than 700-fold increased risk of cardiac death in affected individuals compared with healthy children of the same age. The prevalence of ESRD is low in children, however, and, consequently, few cardiac deaths occur. As a result, prospective follow-up studies of cardiac risk factors in the pediatric setting are lacking. Nevertheless, cross-sectional data on cardiac disease in children with ESRD have started to emerge. Arterial medial calcification is more prominent in children than classic atherosclerotic intimal calcification. Current data suggest that endothelial dysfunction appears early in renal failure in children, and is followed by arterial medial calcification. This calcification causes arterial wall stiffening and subsequently left ventricular hypertrophy. High systolic blood pressure and serum concentrations of intact parathyroid hormone, calcium and phosphate, as well as long-term dialysis, seem to be important risk factors for cardiovascular disease in pediatric patients with ESRD. These features are important targets for preventive intervention. This Review summarizes the currently available data on cardiovascular disease in children with renal failure.

Key Points

  • Children with chronic kidney disease or end-stage renal disease have an increased risk of cardiovascular death

  • Sudden cardiac death is the most common cause of cardiovascular death in children with renal failure

  • Arterial medial calcification (which increases arterial stiffness), left ventricular hypertrophy and endothelial dysfunction are prevalent in children with renal failure

  • Several modifiable factors predict cardiovascular abnormalities in children with chronic kidney disease or end-stage renal disease, including hyperphosphatemia, anemia, insufficient blood pressure control, high intake of calcium salts or active vitamin D and high serum levels of intact parathyroid hormone

  • Transplantation and intensified hemodialysis regimens can minimize several of the modifiable risk factors described above

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands

    Marc R. Lilien

  2. Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands

    Jaap W. Groothoff

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  1. Marc R. Lilien
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  2. Jaap W. Groothoff
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Corresponding author

Correspondence to Marc R. Lilien.

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Competing interests

Marc R. Lilien's department has received an unrestricted research grant from Ferring Pharmaceuticals BV, The Netherlands.

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Lilien, M., Groothoff, J. Cardiovascular disease in children with CKD or ESRD. Nat Rev Nephrol 5, 229–235 (2009). https://doi.org/10.1038/nrneph.2009.10

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