Changes in the Cardiovascular Risk Profile in Children Approaching Kidney Replacement Therapy

Published: Jan. 1, 2024

Background: Despite significant cardiovascular (CV) morbidity in children on dialysis and after kidney transplantation, data the evolution of CV damage with chronic disease (CKD) approaching replacement therapy (KRT) is unknown.Methods: The burden, progression, predictors before KRT onset were explored prospective multicenter cohorts: Cardiovascular Comorbidity Children CKD (4C) Haemodiafiltration, Heart Height (3H) studies. risk factors evaluated (i) cross sectionally at KRT-start (n=248), (ii) longitudinally over 2-years preceding start (n=157; 331 patient-visits). Longitudinal analyses withmixed-effects models estimated associations modifiable change carotid intima-media thickness (cIMT) standard deviation score (SDS), pulse wave velocity (PWV-SDS), left ventricular (LV) mass systolic dysfunction.Findings: 248 patients, age 14·3 (12·2, 16·2) years median 35 (28-114) days start. . Elevated cIMT-SDS PWV-SDS present 43% 25%, LV hypertrophy dysfunction 49% 33%. Aortic stiffness significantly increased, especially year (adjusted odds ratio, OR 0·33, P=0·002 0·54, P=0·01, respectively). 79% had >3 onset. Diastolic BP BMI strongly associated a linear increase all measures. After controlling for factors, time to no longer predicted burden damage.Interpretation: This comprehensive evaluation shows progressive accrual high onset, largely from factors.Funding: Support 4C Study was received ERA-EDTA Research Programme, KfH Foundation Preventive Medicine German Federal Ministry Education (01EO0802) Roche Organ Transplant (365520785). study also supported by European Reference Network Rare Kidney Diseases (ERKNet), which funded Union within framework EU4Health Programme (101085068). 3H sponsored UK (RP39/2013). Part sponsorship obtained Fresenius Medical Care. A part work took place Biomedical Centre UCL Great Ormond Street Hospital Children, London.Declaration Interest: None.Ethical Approval: Ethical aspects details acquisition are described elsewhere. Both studies designed performed according Declaration Helsinki. protocols approved each local institutional review boards. Written informed consent parents adolescents, assent younger children.

Language: Английский

Association of arterial stiffness with chronic kidney disease: a systematic review

Kidney & Blood Pressure Research, Journal Year: 2024, Volume and Issue: 49(1), P. 763 - 772

Published: Aug. 27, 2024

Significant kidney function may be lost before CKD is diagnosed. Arterial stiffness a risk factor for and the relationship bi-directional. A systematic review of cohort studies was undertaken to ascertain temporal arterial CKD.

Language: Английский

Wall Properties of Elastic and Muscular Arteries in Children and Adolescents at Increased Cardiovascular Risk

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(21), P. 6919 - 6919

Published: Nov. 3, 2023

Pulse wave velocity (PWV) assessment represents a simple method to estimate arterial distensibility. At present, carotid-femoral PWV (cf-PWV) is considered the gold standard in non-invasive evaluation of elastic properties aorta. On other hand, mechanical muscular arteries can be evaluated on axillo-brachial-radia axis by estimating carotid-radial (cr-PWV). While number studies have addressed these issues adults, limited information available respective features cf-PWV and cr-PWV their modulating factors children adolescents at increased cardiovascular risk. The predominantly (aorta) (axillo-brachial-radial axis) were pediatric population characterized either elevated blood pressure (BP) or excess body weight, main affecting values individuals investigated. 443 (median age 11.5 years, 43.3% females) enrolled; 25% had BP >90th percentile 81% weight. significantly lower than values: median (Q1-Q3) = 4.8 m/s (4.3-5.5) 5.8 (5.0-6.5), respectively (p < 0.001). pubertal development 0.03), systolic diastolic z-scores 0.002), heart rate 0.001), waist-to-height ratio 0.005) associated with values. No significant association was found between BMI z-score cf-PWV. Predictors high (>95th percentile) (OR 1.07, 95%CI 1.04-1.10, p 0.001) 1.06, 1.0-1.13, 0.04). variables related 0.01), HOMA index 0.02). ratio. Systolic central obesity are aortic stiffness In contrast, BP, rate, levels insulin resistance appear distensibility upper limb vascular district.

Language: Английский