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Sullivan KM, Kriegel AJ. Growth hormone in pediatric chronic kidney disease: more than just height. Pediatr Nephrol 2024; 39:3167-3175. [PMID: 38607423 DOI: 10.1007/s00467-024-06330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/24/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
Recombinant human growth hormone therapy, which was introduced in the 1980s, is now routine for children with advanced chronic kidney disease (CKD) who are exhibiting growth impairment. Growth hormone usage remains variable across different centers, with some showing low uptake. Much of the focus on growth hormone supplementation has been on increasing height because of social and psychological effects of short stature. There are, however, numerous other changes that occur in CKD that have not received as much attention but are biologically important for pediatric growth and development. This article reviews the current knowledge about the multisystem effects of growth hormone therapy in pediatric patients with CKD and highlights areas where additional clinical research is needed. We also included clinical data on children and adults who had received growth hormone for other indications apart from CKD. Ultimately, having robust clinical studies which examine these effects will allow children and their families to make more informed decisions about this therapy.
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Affiliation(s)
- Katie Marie Sullivan
- Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alison J Kriegel
- Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA.
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2
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Larkins NG, Craig JC. Hypertension and Cardiovascular Risk Among Children with Chronic Kidney Disease. Curr Hypertens Rep 2024; 26:389-398. [PMID: 38806767 PMCID: PMC11416368 DOI: 10.1007/s11906-024-01308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the most common cause of mortality across the lifespan of children with chronic kidney disease (CKD). Hypertension is a common and important contributor, but other factors such as obesity, dyslipidemia and mineral bone disease play a role. This narrative review focusses on studies published in the past five years that have investigated hypertension and cardiovascular risk among children with CKD. RECENT FINDINGS Cohort studies such as Chronic Kidney Disease in Children (CKiD) and Cardiovascular Comorbidity in Children with CKD (4C) have continued to develop our understanding of blood pressure (BP) phenotypes, and of progressive changes in the structure and function of the heart and blood vessels occurring in children with CKD. Metabolic risk factors, such as dyslipidemia, may represent an under-recognized component of care. Trial data are less common than observational evidence, but support lifestyle interventions currently used, mainly the low sodium dietary approaches to stop hypertension (DASH) diet. The findings of the recently reported Hypertension Optimal Treatment in Children with Chronic Kidney Disease trial (HOT-KID) are described in relation to the use of office BP treatment targets. Cardiovascular health is critical to the long-term outcomes of children with CKD. Recognizing and treating hypertension remains a critical component to improving outcomes, along with measures to improve concurrent cardiovascular risk factors. Some cardiovascular changes may not be reversible with transplantation and further research is needed for children at all stages of CKD.
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Affiliation(s)
- Nicholas G Larkins
- Department of Nephrology and Hypertension, Perth Children's Hospital, Nedlands, Australia.
- Medical School, University of Western Australia, Perth, Australia.
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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3
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Khandelwal P, Hofstetter J, Azukaitis K, Bayazit A, Doyon A, Duzova A, Canpolat N, Bulut IK, Obryck L, Ranchin B, Paripovic D, Bakkaloglu S, Alpay H, Arbeiter K, Litwin M, Zaloszyc A, Paglialonga F, Borzych-Dużałka D, Schmitt CP, Melk A, Querfeld U, Schaefer F, Shroff R. Changes in the cardiovascular risk profile in children approaching kidney replacement therapy. EClinicalMedicine 2024; 74:102708. [PMID: 39050108 PMCID: PMC11268110 DOI: 10.1016/j.eclinm.2024.102708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Background Despite significant cardiovascular (CV) morbidity in children on dialysis and after kidney transplantation, data on the evolution of CV damage in children with chronic kidney disease (CKD) approaching kidney replacement therapy (KRT) is unknown. Methods The burden, progression, and predictors of CV damage before KRT onset were explored in two prospective multicenter cohorts from Europe and Canada: Cardiovascular Comorbidity in Children with CKD (4C) and Haemodiafiltration, Heart and Height (3H) studies, conducted from 2009-19 and 2013-16, respectively. CV damage and risk factors were evaluated (i) cross sectionally at KRT-start (n = 248), and (ii) longitudinally over the 2-years preceding KRT start (n = 157; 331 patient-visits). Longitudinal analyses with mixed-effects models estimated associations of modifiable CV risk factors with change in carotid intima-media thickness (cIMT) standard deviation score (SDS), pulse wave velocity (PWV-SDS), left ventricular (LV) mass and systolic dysfunction. Findings 248 patients, age 14.3 (12.2, 16.2) years were evaluated at median 35 (28-114) days before KRT start. Elevated cIMT-SDS and PWV-SDS were present in 43% and 25%, and LV hypertrophy and systolic dysfunction in 49% and 33%. Aortic stiffness and LV hypertrophy significantly increased, especially in the year before KRT start (adjusted odds ratio, OR 0.33, P = 0.002 and OR 0.54, P = 0.01, respectively). 79% of children had >3 modifiable CV risk factors at KRT onset. Diastolic BP and BMI were strongly associated with a linear increase in all CV measures. After controlling for CV risk factors, the time to KRT onset no longer predicted the burden of CV damage. Interpretation This comprehensive CV evaluation shows the progressive accrual of modifiable risk factors and a high burden of CV damage in the years preceding KRT onset. CV damage in the pre-KRT period is preventable. Funding Supported by EU4Health Programme (101085068) and Kidney Research UK (RP39/2013).
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Affiliation(s)
- Priyanka Khandelwal
- Division of Pediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Jonas Hofstetter
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun Bayazit
- Department of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, Türkiye
| | - Anke Doyon
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Duzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Nur Canpolat
- Division of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Ipek Kaplan Bulut
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Lukasz Obryck
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Dusan Paripovic
- Department of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | - Sevcan Bakkaloglu
- Pediatric Nephrology Unit, Gazi University Hospital, Ankara, Türkiye
| | - Harika Alpay
- Department of Pediatric Nephrology, Marmara University Medical School, Istanbul, Türkiye
| | - Klaus Arbeiter
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Mieczyslaw Litwin
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Ariane Zaloszyc
- Pediatric Nephrology Unit, Hautepierre University Hospital, Strasbourg, France
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Claus Peter Schmitt
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Uwe Querfeld
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin, Berlin, Germany
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Rukshana Shroff
- Division of Pediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - 4C and 3H study investigators
- Division of Pediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, Türkiye
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
- Division of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Türkiye
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
- Department of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
- Pediatric Nephrology Unit, Gazi University Hospital, Ankara, Türkiye
- Department of Pediatric Nephrology, Marmara University Medical School, Istanbul, Türkiye
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Pediatric Nephrology Unit, Hautepierre University Hospital, Strasbourg, France
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Pediatric Nephrology Unit, Medical University of Gdansk, Gdansk, Poland
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin, Berlin, Germany
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Zhang J, Yang Z, Fan X, Fei Q, Xi Y. Positive Correlation between BMI and Left Ventricle and Atrium Inside Diameter Size in Chinese Type 2 Diabetes Patients with Left Ventricular and Atrial Enlargement. Rev Cardiovasc Med 2024; 25:207. [PMID: 39076313 PMCID: PMC11270061 DOI: 10.31083/j.rcm2506207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 07/31/2024] Open
Abstract
Background Patients with type 2 diabetes mellitus (T2DM) commonly exhibit overlooked left ventricular and atrial hypertrophy. This research identifies potential risk factors and intervention targets. Methods T2DM patients with normal ejection fraction values were enrolled, while we eliminated influences on heart size, such as hypertension and coronary heart disease. Variables for each participant, including height, weight, age, body mass index (BMI), and blood biochemistry, were recorded before patients were categorized into four groups based on heart size. Multiple linear regression and Pearson's correlation analyses were applied to investigate the possible correlations. Results Three years of clinical data were collected for each T2DM patient, while patients with incomplete data or interference factors affecting heart size were excluded. BMI, adjusted fasting blood glucose (FBG), glomerular filtration rate (eGFR), and age all showed a significant positive correlation with the inner diameter of the left ventricle and atrium in groups exhibiting hypertrophy. Conclusions In T2DM patients, BMI correlated positively with left ventricular enlargement, suggesting its potential role as a risk factor. Weight control may be an effective intervention for left ventricular enlargement, to reduce the likelihood of heart failure.
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Affiliation(s)
- Jie Zhang
- Department of Endocrinology, Ningbo No.2 Hospital, 315000 Ningbo, Zhejiang, China
| | - Zhenhua Yang
- Department of Endocrinology, Ningbo No.2 Hospital, 315000 Ningbo, Zhejiang, China
| | - Xiaoxiang Fan
- Department of Endocrinology, Ningbo No.2 Hospital, 315000 Ningbo, Zhejiang, China
| | - Qiuping Fei
- Department of Endocrinology, Ningbo No.2 Hospital, 315000 Ningbo, Zhejiang, China
| | - Yingfei Xi
- Department of Endocrinology, Ningbo No.2 Hospital, 315000 Ningbo, Zhejiang, China
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Zhou Y, Zhao L, Zhang Z, Meng X, Cai QJ, Zhao XL, Wang LP, Hu AH, Zhou XL. Sex difference in nocturnal blood pressure dipping in adolescents with varying degrees of adiposity. BMC Pediatr 2024; 24:353. [PMID: 38778302 PMCID: PMC11110230 DOI: 10.1186/s12887-024-04804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND For adolescents, abnormal dipping patterns in blood pressure (BP) are associated with early-onset organ damage and a higher risk of cardiovascular disorders in adulthood. Obesity is one of the most common reasons for abnormal BP dipping in young people. However, it is unknown whether the severity of obesity is associated with BP dipping status and whether this association is sex-dependent. METHODS 499 participants between 12 and 17 years old with overweight or obesity underwent ambulatory blood pressure monitoring (ABPM) between April 2018 and January 2019 in Beijing and Baoding. Participants were grouped by body mass index (BMI) into overweight (BMI 85th-95th percentile), obese (BMI ≥ 95th percentile) and severely obese (BMI ≥ 120% of 95th percentile or ≥ 35 kg/m2) groups. Non-dipping was defined as a < 10% reduction in BP from day to night. The interaction effect between sex and obesity degree was also analyzed. RESULTS 326 boys and 173 girls were included, of whom 130 were overweight, 189 were obese, and 180 were severely obese. Girls with severe obesity had a higher prevalence of non-dipping, but boys showed no significant differences in BP dipping status between obesity categories. In addition, as obesity severity went up, a more evident increase in night-time SBP was observed in girls than in boys. CONCLUSIONS Severely obese is associated with a higher prevalence of non-BP dipping patterns in girls than in boys, which suggests that the relationship between the severity of obesity and BP dipping status might be sex-specific.
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Affiliation(s)
- Yi Zhou
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Zenglei Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Qiu-Jing Cai
- Department of Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiao-Lei Zhao
- Department of Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lin-Ping Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Ai-Hua Hu
- Department of Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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6
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Padoan F, Guarnaroli M, Brugnara M, Piacentini G, Pietrobelli A, Pecoraro L. Role of Nutrients in Pediatric Non-Dialysis Chronic Kidney Disease: From Pathogenesis to Correct Supplementation. Biomedicines 2024; 12:911. [PMID: 38672265 PMCID: PMC11048674 DOI: 10.3390/biomedicines12040911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Nutrition management is fundamental for children with chronic kidney disease (CKD). Fluid balance and low-protein and low-sodium diets are the more stressed fields from a nutritional point of view. At the same time, the role of micronutrients is often underestimated. Starting from the causes that could lead to potential micronutrient deficiencies in these patients, this review considers all micronutrients that could be administered in CKD to improve the prognosis of this disease.
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Affiliation(s)
| | | | - Milena Brugnara
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (A.P.)
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7
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Anderson CE, Gilbert RD, Harmer M, Ritz P, Wootton S, Elia M. Estimating Total Energy Expenditure to Determine Energy Requirements in Free-Living Children With Stage 3 Chronic Kidney Disease: Can a Structured Approach Help Improve Clinical Care? J Ren Nutr 2024; 34:11-18. [PMID: 37473976 DOI: 10.1053/j.jrn.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE Malnutrition and obesity are complex burdensome challenges in pediatric chronic kidney disease (CKD) management that can adversely affect growth, disease progression, wellbeing, and response to treatment. Total energy expenditure (TEE) and energy requirements in children are essential for growth outcomes but are poorly defined, leaving clinical practice varied and insecure. The aims of this study were to explore a practical approach to guide prescribed nutritional interventions, using measurements of TEE, physical activity energy expenditure (PAEE), and their relationship to kidney function. DESIGN AND METHODS In a cross-sectional prospective age-matched and sex-matched controlled study, 18 children with CKD (6-17 years, mean stage 3) and 20 healthy, age-matched, and gender-matched controls were studied. TEE and PAEE were measured using basal metabolic rate (BMR), activity diaries and doubly labeled water (healthy subjects). Results were related to estimated glomerular filtration rate (eGFR). The main outcome measure was TEE measured by different methods (factorial, doubly labeled water, and a novel device). RESULTS Total energy expenditure and PAEE with or without adjustments for age, gender, weight, and height did not differ between the groups and was not related to eGFR. TEE ranged from 1927 ± 91 to 2330 ± 73 kcal/d; 95 ± 5 to 109 ± 5% estimated average requirement (EAR), physical activity level (PAL) 1.52 ± 0.01 to 1.71 ± 0.17, and PAEE 24 to 34% EAR. Comparisons between DLW and alternative methods in healthy children did not differ significantly, except for 2 (factorial methods and a fixed PAL; and the novel device). CONCLUSION In clinical practice, structured approaches using supportive evidence (weight, height, BMI sds), predictive BMR or TEE values and simple questions on activity, are sufficient for most children with CKD as a starting energy prescription.
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Affiliation(s)
- Caroline E Anderson
- Department of Nutrition and Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK; The NIHR Southampton Biomedical Research Centre, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Dietetic Programme, Faculty of Health and Wellbeing, University of Winchester, Winchester, UK.
| | - Rodney D Gilbert
- Department of Nutrition and Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matthew Harmer
- Department of Nutrition and Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK; The NIHR Southampton Biomedical Research Centre, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Stephen Wootton
- The NIHR Southampton Biomedical Research Centre, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marinos Elia
- The NIHR Southampton Biomedical Research Centre, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
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8
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Carlson J, Gerson AC, Matheson MB, Manne S, Lande M, Harshman L, Johnson RJ, Shinnar S, Kogon AJ, Warady B, Furth S, Hooper S. Longitudinal changes of health-related quality of life in childhood chronic kidney disease. Pediatr Nephrol 2023; 38:4127-4136. [PMID: 37428223 PMCID: PMC10591962 DOI: 10.1007/s00467-023-06069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Few longitudinal studies have evaluated the impact of chronic kidney disease (CKD) duration on health-related quality of life (HRQOL). The study's aim was to determine how HRQOL changes over time in childhood CKD. METHODS Study participants were children in the chronic kidney disease in children (CKiD) cohort who completed the pediatric quality of life inventory (PedsQL) on three or more occasions over the course of two or more years. Generalized gamma (GG) mixed-effects models were applied to assess the effect of CKD duration on HRQOL while controlling for selected covariates. RESULTS A total of 692 children (median age = 11.2) with a median of 8.3 years duration of CKD were evaluated. All subjects had a GFR greater than 15 ml/min/1.73 m2. GG models with child self-report PedsQL data indicated that longer CKD duration was associated with improved total HRQOL and the 4 domains of HRQOL. GG models with parent-proxy PedsQL data indicated that longer duration was associated with better emotional but worse school HRQOL. Increasing trajectories of child self-report HRQOL were observed in the majority of subjects, while parents less frequently reported increasing trajectories of HRQOL. There was no significant relationship between total HRQOL and time-varying GFR. CONCLUSIONS Longer duration of the disease is associated with improved HRQOL on child self-report scales; however, parent-proxy results were less likely to demonstrate any significant change over time. This divergence could be due to greater optimism and accommodation of CKD in children. Clinicians can use these data to better understand the needs of pediatric CKD patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Joann Carlson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Arlene C Gerson
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sharon Manne
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Marc Lande
- University of Rochester Medical Center, Rochester, NY, USA
| | - Lyndsay Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Rebecca J Johnson
- Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Shlomo Shinnar
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amy J Kogon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Warady
- Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO, USA
| | - Susan Furth
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Hooper
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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9
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Mak RH, Iyengar A, Lai WM, McAlister L, Oliveira EA, Xu H, Yap HK, Shroff R. Nutrition in Children With Chronic Kidney Disease: How to Thrive? J Ren Nutr 2023; 33:S49-S55. [PMID: 37558172 DOI: 10.1053/j.jrn.2023.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/21/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
The nutritional status and management of children with chronic kidney disease (CKD) are complex and require a combined pediatric nephrology team work approach with physicians, nutritionists, nurses, and physical/occupational therapists. Prospective observational studies such as Children with CKD in the US, the 4C study in Europe and the International Pediatric Peritoneal Dialysis Network have advanced the field. However, most recommendations and guidelines from international task forces such as Kidney Diseases Improving Global Outcomes and Pediatric Renal Nutrition Taskforce are opinion-based rather than evidence-based. There is exciting ongoing research to improve nutrition in children with CKD to help them thrive.
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Affiliation(s)
- Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California San Diego, La Jolla.
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bangalore, India
| | - Wai Ming Lai
- Paediatric Nephrology Center, Hong Kong Children's Hospital, Hong Kong
| | | | - Eduardo A Oliveira
- Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Hong Xu
- Department of Pediatric Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Hui Kim Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rukshana Shroff
- Division of Paediatric Nephrology, Institute of Child Health, London, United Kingdom
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10
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Prytuła A, Grenda R. Anthropometric measures and patient outcome in pediatric chronic kidney disease. Pediatr Nephrol 2023; 38:3207-3210. [PMID: 37199813 DOI: 10.1007/s00467-023-06017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Agnieszka Prytuła
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, ERKNet Center, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation & Hypertension, Children's Memorial Health Institute, Warsaw, Poland
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Bonthuis M, Bakkaloglu SA, Vidal E, Baiko S, Braddon F, Errichiello C, Francisco T, Haffner D, Lahoche A, Leszczyńska B, Masalkiene J, Stojanovic J, Molchanova MS, Reusz G, Barba AR, Rosales A, Tegeltija S, Ylinen E, Zlatanova G, Harambat J, Jager KJ. Associations of longitudinal height and weight with clinical outcomes in pediatric kidney replacement therapy: results from the ESPN/ERA Registry. Pediatr Nephrol 2023; 38:3435-3443. [PMID: 37154961 PMCID: PMC10465625 DOI: 10.1007/s00467-023-05973-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT. METHODS We included patients < 20 years starting KRT in 33 European countries from 1995-2019 with height and weight data recorded to the ESPN/ERA Registry. We defined short stature as height standard deviation scores (SDS) < -1.88 and tall stature as height SDS > 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates. RESULTS We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78-0.86), tall (aHR: 0.65, 95% CI: 0.56-0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71-0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92-2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38-2.23) and obese (aHR: 1.49, 95% CI: 1.11-1.99) patients showed higher all-cause mortality risk than normal weight subjects. CONCLUSIONS Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | | | - Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Sergey Baiko
- Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | | | | | - Telma Francisco
- Department of Pediatric Nephrology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Annie Lahoche
- Department of Pediatric Nephrology, CHRU de Lille, Lille, France
| | - Beata Leszczyńska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Jurate Masalkiene
- Department of Children Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jelena Stojanovic
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - George Reusz
- 1st Department of Pediatrics, Semmelweis University Budapest, Budapest, Hungary
| | | | - Alejandra Rosales
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Sanja Tegeltija
- Department of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Galia Zlatanova
- Department of Pediatric Nephrology, University Children's Hospital "Prof. Ivan Mitev", Sofia, Bulgaria
| | - Jérôme Harambat
- Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Kitty J Jager
- ESPN/ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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12
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Zhan C, Peng Y, Ye H, Diao X, Yi C, Guo Q, Chen W, Yang X. Triglyceride glucose-body mass index and cardiovascular mortality in patients undergoing peritoneal dialysis: a retrospective cohort study. Lipids Health Dis 2023; 22:143. [PMID: 37670344 PMCID: PMC10478298 DOI: 10.1186/s12944-023-01892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Recent studies have shown that triglyceride glucose-body mass index (TyG-BMI) is associated with the risk of ischemic stroke and coronary artery disease. However, little attention has been given to the association between TyG-BMI and cardiovascular disease (CVD) mortality in patients undergoing peritoneal dialysis (PD). Therefore, this study aimed to explore the relationship between TyG-BMI and CVD mortality in southern Chinese patients undergoing PD. METHODS Incident patients receiving PD from January 1, 2006, to December 31, 2018, with baseline serum triglyceride, glucose, and body mass index (BMI) information, were recruited for this single-center retrospective cohort study. TyG-BMI was calculated based on fasting plasma glucose, triglyceride, and BMI values. The association between TyG-BMI, CVD and all-cause mortality was evaluated using a multivariate-adjusted Cox proportional hazard regression model. RESULTS Of 2,335 patients, the mean age was 46.1 ± 14.8 years; 1,382 (59.2%) were male, and 564 (24.2%) had diabetes. The median TyG-BMI was 183.7 (165.5-209.2). Multivariate linear regression showed that advanced age, male sex, history of CVD, higher levels of albumin and low-density lipoprotein cholesterol, and higher urine output were correlated with a higher TyG-BMI (P < 0.05). During a median follow-up period of 46.6 (22.4-78.0) months, 615 patients died, of whom 297 (48.2%) died as a result of CVD. After adjusting for demographics and comorbidities, TyG-BMI was significantly associated with an increased risk of CVD mortality (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.05-2.17) and all-cause mortality (HR 1.36, 95% CI 1.05-1.75). After full adjustment, the 28% risk of CVD mortality (HR 1.28, 95% CI 1.13-1.45) and 19% risk of all-cause mortality were elevated (HR 1.19, 95% CI 1.09-1.31) when TyG-BMI increased by 1 stand deviation (SD) (34.2). CONCLUSIONS A higher baseline TyG-BMI was independently associated with an increased risk of CVD and all-cause mortality in patients receiving PD.
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Affiliation(s)
- Cuixia Zhan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
- Department of Nephrology, Ganzhou People's Hospital (The Affiliated Ganzhou Hospital of Nanchang University), Ganzhou, 341000, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.
- NHC Key Laboratory of Clinical Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, 510080, China.
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Sugianto RI, Saenger T, Ahn C, Chong AS, Goldberg AM, Grabitz C, Mannon RB, Marson L, Memaran N, Sapir-Pichhadze R, Tullius SG, von der Born J, West LJ, Foster BJ, Lerminiaux L, Wong G, Melk A. State-of-the-art Meeting on Sex and Gender in Transplantation: The Female Perspective. Transplantation 2023; 107:1865-1869. [PMID: 37101316 DOI: 10.1097/tp.0000000000004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Rizky Indrameikha Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Thorsten Saenger
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Anita S Chong
- Department of Surgery, University of Chicago, Chicago, IL
| | - Aviva M Goldberg
- Section of Pediatric Nephrology, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Roslyn B Mannon
- Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Lorna Marson
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Stefan G Tullius
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Lori J West
- Departments of Pediatrics, Surgery, Medical Microbiology/Immunology and Laboratory Medicine/Pathology, University of Alberta, Alberta Transplant Institute, Edmonton, AB, Canada
| | - Bethany J Foster
- Department of Pediatrics, Montreal Children's Hospital of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Germaine Wong
- Division of Nephrology, Department of Medicine, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Mak RH, Iyengar A, Wang AYM. Nutrition Management for Chronic Kidney Disease: Differences and Special Needs for Children and Adults. Semin Nephrol 2023; 43:151441. [PMID: 37981474 DOI: 10.1016/j.semnephrol.2023.151441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Common goals of nutritional therapy across the spectrum of pediatric and adult chronic kidney disease (CKD) include maintaining normal body mass and composition and reducing associated morbidity and mortality. Adult nephrologists caring for children and adolescents may be challenged by the existing complexities in identifying and interpreting the nutritional status and growth in children. Pediatric nephrologists may face situations that call for a sound knowledge of assessing nutritional status and providing nutrition therapy for adolescents and young adults. One important additional nutrition goal in children is to achieve normal growth and development. Children are growing and therefore need more calories and nutrients than just maintaining their body weight and composition. Lack of weight and height gain actually is considered failure to thrive in children. Some fundamental differences in approaches to nutritional therapy in CKD are necessitated based on the etiology of CKD. A large proportion of adults with CKD are diabetics, so the approach would be a low-carbohydrate diet. Children with CKD, especially young ones, often are anorexic, so calorie supplements that could include quite a lot of carbohydrates often are prescribed. More adults with CKD have hypertension and atherosclerotic comorbidities, which result in recommendations for low-salt and low-fat diets. Children with CKD often have salt and electrolyte wasting disease states and would require normal- or even high-salt diets, and fats often are included in supplements to bolster calorie intake. Low-protein diets often are recommended in adults with predialysis CKD to slow disease progression. Children are growing and have a higher protein daily requirement. Low-protein diets have not been found to be efficacious in children with CKD, in achieving normal growth, or in slowing disease progression. Adult nephrologists caring for children and adolescents may be challenged by the existing complexities in identifying and interpreting nutritional status and growth in children. Pediatric nephrologists may face situations that call for a sound knowledge of assessing nutritional status and providing nutrition therapy for adolescents and young adults. This article discusses the differences in the assessment of nutritional status between children and adults, as well as provides a comprehensive approach to nutritional management for CKD across the age spectrum. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, CA.
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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15
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Drożdż M, Moczulska A, Rudziński A, Drożdż D. Metabolic syndrome as risk factor for left ventricular hypertrophy in children with chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1215527. [PMID: 37324258 PMCID: PMC10264689 DOI: 10.3389/fendo.2023.1215527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background The metabolic syndrome (MS), a cluster of clinical and biochemical abnormalities including insulin resistance, dyslipidemia and hypertension, is often diagnosed in chronic kidney disease (CKD) children. Left ventricular hypertrophy (LVH) is a major target organ damage in hypertension and an important cardiovascular risk factor in CKD patients. We aimed to identify the most significant risk factors of LVH in children with CKD. Methods Children with CKD stage 1-5 were enrolled in the study. MS was diagnosed according to De Ferranti (DF) as ≥3 from 5 criteria. Ambulatory blood pressure measurements (ABPM) and echocardiographic evaluation were performed. LVH was defined as ≥95th percentile of LV mass index related to height and age. Clinical and laboratory parameters included: serum albumin, Ca, HCT, cystatin C, creatinine, estimated glomerular filtration rate (eGFR) based on Schwartz formula, triglycerides, high-density lipoprotein (HDL), proteinuria, BMI standard deviation score (SDS), height SDS, waist circumference, ABPM data. Results 71 children (28 girls/43 boys) with median age 14.05 (25%-75%:10.03-16.30) years and median eGFR 66.75 (32.76-92.32) ml/min/1.73m2 were evaluated. CKD stage 5 was diagnosed in 11 pts (15.5%). MS (DF) was diagnosed in 20 pts (28.2%). Glucose ≥ 110 mg/dL was present in 3 pts (4.2%); waist circumference ≥75th pc in 16 pts (22.5%); triglycerides ≥ 100 mg/dL in 35 pts (49.3%); HDL < 50mg/dL in 31 pts (43.7%) and BP ≥ 90th pc in 29 pts (40.8%), respectively. LVH was detected in 21 (29.6%) children. In univariate regression the strongest risk factor for LVH was CKD stage 5 (OR 4.9, p=0.0019) and low height SDS (OR 0.43,p=0.0009). In stepwise multiple logistic regression analysis (logit model) of the most important risk factors for LVH in CKD children, only three were statistically significant predictors: 1)MS diagnosis based on DF criteria (OR=24.11; 95%CI 1.1-528.7; p=0.043; Chi2 = 8.38,p=0.0038); 2), high mean arterial pressure (MAP SDS) in ABPM (OR=2.812; 95%CI 1.057-7.48; p=0.038;Chi2 = 5.91, p=0.015) and 3) low height SDS (OR=0.078; 95%CI 0.013-0.486;p=0.006; Chi2 = 25.01, p<0.001). Conclusions In children with chronic kidney disease LVH is associated with the cluster of multiple factors, among them the components of MS, hypertension, stage 5 CKD and growth deficit were the most significant.
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Affiliation(s)
- Monika Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Moczulska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Rudziński
- Department of Pediatric Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
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16
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Binka E, Urbina EM, Manlhiot C, Alsaied T, Brady TM. Association of Childhood Blood Pressure with Left Atrial Size and Function: Study of High Blood Pressure in Pediatrics-Adult Hypertension in Youth (SHIP AHOY). J Pediatr 2023; 255:190-197.e1. [PMID: 36470463 PMCID: PMC10121756 DOI: 10.1016/j.jpeds.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE(S) To evaluate the cross-sectional association of cardiovascular disease risk factors with left atrial (LA) size and function among healthy youth, aged 11-18 years, with a wide range of blood pressures (BPs). STUDY DESIGN Echocardiographic images of youth enrolled in the Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth study were analyzed for LA measurements. The association of casual BP, ambulatory BP, and other cardiovascular disease risk factors with LA size and function were determined using descriptive statistics and multivariable regression. Regression models adjusting for age, sex, race, and body mass index z score determined the independent association between ambulatory systolic BP indices (mean systolic BP/50th %ile systolic BP) and BP phenotypes with LA outcomes while exploratory analyses investigated for additional predictors of LA outcomes. RESULTS The study population consisted of 347 youth: median age 15.7 years, 60% male and 40% non-White. Greater-risk casual systolic BP groups had worse cardiometabolic profiles but no differences in LA size and function. Each 0.1 increase in ambulatory systolic BP day or night index was associated with a 9.9 mL/m2 increase in LA volume/body surface area (LAV/BSA; 95th% CI 2.8-17.0, P = .006) and a 6.8 mL/m2 increase in LAV/BSA (95th% CI 0.8-12.8, P = .03), respectively. Ambulatory hypertension was associated with greater odds of abnormal LAV/BSA, defined as >75th %ile (2014 ambulatory BP monitoring criteria: OR 3.2 [95th% CI 1.4-7.2; P = .002]; 2022 ambulatory BP monitoring criteria: OR 2.1 [95th% CI 1.0-4.1; P = .008]). CONCLUSIONS Increasing ambulatory systolic BP and ambulatory hypertension are independently associated with LAV/BSA.
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Affiliation(s)
- Edem Binka
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT.
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cedric Manlhiot
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tarek Alsaied
- The Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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17
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Villasis-Keever MA, Zurita-Cruz JN, Zepeda-Martinez C, Alegria-Torres G, Serret-Montoya J, Estrada-Loza MDJ, Hernández-Hernández BC, Alonso-Flores S, Zavala-Serret M. Adipokines as predictive factor of cardiac function in pediatric patients with chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1120445. [PMID: 36967775 PMCID: PMC10034059 DOI: 10.3389/fendo.2023.1120445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Background Adipokines are associated with cardiovascular disease; in chronic kidney disease (CKD) patients adipokines could be useful prognostic factors. Objectives To explore whether leptin and adiponectin in kidney replacement therapy (KRT) children could have a role on their cardiac function, in the long-term. Design Prospective cohort study was performed with pediatric KRT patients, aged 8 to 17 years who were undergoing hemodialysis or peritoneal dialysis. At enrollment, lipid profile, adipokines (leptin, leptin receptor, free leptin, and adiponectin), anthropometric measurements and cardiological evaluation were determined. At two-year follow-up, a new cardiological evaluation was performed. Statistical analysis: Quantitative data are presented as median and interquartile range (IQR). Mann-Whitney U test and Chi-squared were used for the between-group comparison. Multivariate analyzes were performed to determine the association of adipokines levels with ventricular ejection fraction (LEVF). Results We included 56 patients, with a median age of 12.5 years. In the first cardiological evaluation, median LVEF was 70.0% (IQR 61%, 76%), 20 patients (35.7%) had some cardiovascular condition, and 10 (17.8%) altered LVEF. At 24-month follow-up, the median LVEF was 70.5% (IQR 65.1%, 77%), while the delta-LVEF values was 3% (IQR -6.5%, 7%). Delta-LVEF were correlated with baseline adipokines serum levels, and the only positive correlation found was with free leptin (r=0.303, p=0.025). In multivariate analysis, levels of free leptin (Coef. 0.12, p<0.036) and leptin (coef. 1.72, p=0.049), as well as baseline LVEF (Coef. -0.65, p<0.001) were associated with delta-LVEF. Conclusions Free leptin, leptin and LVEF at the beginning of follow-up were associated with the LVEF decrease at the 24-month follow-up in KRT children.
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Affiliation(s)
- Miguel Angel Villasis-Keever
- Research Unit in Analysis and Synthesis of the Evidence, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jessie Nallely Zurita-Cruz
- Hospital Infantil de Mexico Federico Gómez, Facultad de Medicina Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Claudia Zepeda-Martinez
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gabriela Alegria-Torres
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juana Serret-Montoya
- Adolescent Medicine Service, Hospital Infantil de Mexico Federico Gómez, Ministry of Health, Secretaria de Salud (SSA), Mexico City, Mexico
| | - Maria de Jesus Estrada-Loza
- Department of Pediatric Cardiology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Beatriz Carolina Hernández-Hernández
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sara Alonso-Flores
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Monica Zavala-Serret
- Adolescent Medicine Service, Hospital Infantil de Mexico Federico Gómez, Ministry of Health, Secretaria de Salud (SSA), Mexico City, Mexico
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18
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Karava V, Dotis J, Kondou A, Printza N. Malnutrition Patterns in Children with Chronic Kidney Disease. Life (Basel) 2023; 13:life13030713. [PMID: 36983870 PMCID: PMC10053690 DOI: 10.3390/life13030713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
Malnutrition is frequent in children with chronic kidney disease (CKD). Apart from undernutrition and protein energy wasting (PEW), overnutrition prevalence is rising, resulting in fat mass accumulation. Sedentary behavior and unbalanced diet are the most important causal factors. Both underweight and obesity are linked to adverse outcomes regarding renal function, cardiometabolic risk and mortality rate. Muscle wasting is the cornerstone finding of PEW, preceding fat loss and may lead to fatigue, musculoskeletal decline and frailty. In addition, clinical data emphasize the growing occurrence of muscle mass and strength deficits in patients with fat mass accumulation, attributed to CKD-related wasting processes, reduced physical activity and possibly to obesity-induced inflammatory diseases, leading to sarcopenic obesity. Moreover, children with CKD are susceptible to abdominal obesity, resulting from high body fat distribution into the visceral abdomen compartment. Both sarcopenic and abdominal obesity are associated with increased cardiometabolic risk. This review analyzes the pathogenetic mechanisms, current trends and outcomes of malnutrition patterns in pediatric CKD. Moreover, it underlines the importance of body composition assessment for the nutritional evaluation and summarizes the advantages and limitations of the currently available techniques. Furthermore, it highlights the benefits of growth hormone therapy and physical activity on malnutrition management.
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The Presence of Testis Determines Aristolochic Acid-Induced Nephrotoxicity in Mice. Toxins (Basel) 2023; 15:toxins15020118. [PMID: 36828432 PMCID: PMC9962534 DOI: 10.3390/toxins15020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Aristolochic acid (AA) is notorious for inducing nephrotoxicity, but the influence of sex on AA-induced kidney injury was not clear. This study sought to investigate sex differences in kidney dysfunction and tubular injury induced by AA. Male and female mice were bilaterally orchiectomized and ovariectomized, respectively. Fourteen days after gonadectomy, the mice were intraperitoneally injected with AA (10 mg/kg body weight/day) daily for 2 days and sacrificed 7 days after the first injection. Body weight, kidney function, and tubular structure were assessed. When compared between male and female non-gonadectomized mice, AA-induced body weight loss was greater in male mice than in female mice. Functional and structural damages in male kidneys were markedly induced by AA injection, but kidneys in AA-injected female mice showed no or mild damages. Ovariectomy had no effect on AA-induced nephrotoxic acute kidney injury in female mice. However, orchiectomy significantly reduced body weight loss, kidney dysfunction, and tubular injury in AA-induced nephrotoxicity in male mice. This study has demonstrated that testis causes AA-induced nephrotoxic acute kidney injury.
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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] [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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21
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VanSickle JS, Warady BA. Chronic Kidney Disease in Children. Pediatr Clin North Am 2022; 69:1239-1254. [PMID: 36880932 DOI: 10.1016/j.pcl.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic kidney disease (CKD) in children occurs mostly due to congenital anomalies of kidney and urinary tract and hereditary diseases. For advanced cases, a multidisciplinary team is needed to manage nutritional requirements and complications such as hypertension, hyperphosphatemia, proteinuria, and anemia. Neurocognitive assessment and psychosocial support are essential. Maintenance dialysis in children with end-stage renal failure has become the standard of care in many parts of the world. Children younger than 12 years have 95% survival after 3 years of dialysis initiation, whereas the survival rate for children aged 4 years or younger is about 82% at one year."
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Affiliation(s)
- Judith Sebestyen VanSickle
- Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Division of Pediatric Nephrology, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Bradley A Warady
- Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Division of Pediatric Nephrology, 2401 Gillham Road, Kansas City, MO 64108, USA
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22
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Panzarino V, Lesser J, Cassani FA. Pediatric Chronic Kidney Disease. Adv Pediatr 2022; 69:123-132. [PMID: 35985704 DOI: 10.1016/j.yapd.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) in children has a significant impact on morbidity, mortality, and quality of life. The degree of renal dysfunction should be calculated using pediatric-specific formulas and the degree of CKD staged; this allows for appropriate dosing of medications based on renal function and monitoring for progression and comorbid conditions including metabolic acidosis, bone disease, anemia, cardiovascular complications, malnutrition and electrolyte abnormalities, growth failure, and psychosocial issues. Treatment strategies include treating the underlying disease and using general renal protective measures. Effective management of these complex issues requires a specialized multidisciplinary team approach.
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Affiliation(s)
- Valerie Panzarino
- Department of Pediatrics, Division of Pediatric Nephrology, University of South Florida Health, 2 Tampa General Circle, Fifth Floor, Tampa, FL 33606, USA.
| | - Jake Lesser
- University of South Florida Health, 2 Tampa General Circle, Fifth Floor, Tampa, FL 33606, USA
| | - Frank Ayestaran Cassani
- Department of Pediatrics, Division of Pediatric Nephrology, University of South Florida Health, 2 Tampa General Circle, Fifth Floor, Tampa, FL 33606, USA
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23
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Iyengar A, Mak RH. Assessment of Undernutrition in Pediatric Chronic Kidney Disease - Gaps and Opportunities. Front Pediatr 2022; 10:866498. [PMID: 35633955 PMCID: PMC9133715 DOI: 10.3389/fped.2022.866498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Robert H. Mak
- Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
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24
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McKay AM, Teoh CW. Sex differences in cardiovascular disease burden in children with chronic kidney disease. Kidney Int 2022; 101:462-464. [DOI: 10.1016/j.kint.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
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25
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Wyld MLR, Mata NLDL, Viecelli A, Swaminathan R, O'Sullivan KM, O'Lone E, Rowlandson M, Francis A, Wyburn K, Webster AC. Sex-Based Differences in Risk Factors and Complications of Chronic Kidney Disease. Semin Nephrol 2022; 42:153-169. [PMID: 35718363 DOI: 10.1016/j.semnephrol.2022.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Globally, females are ∼30% more likely to have pre-dialysis chronic kidney disease (CKD) than males for reasons that are not fully understood. CKD is associated with numerous adverse health outcomes which makes understanding and working to eradicating sex based disparities in CKD prevalence essential. This review maps both what is known, and what is unknown, about the way sex and gender impacts (1) the epidemiology and risk factors for CKD including age, diabetes, hypertension, obesity, smoking, and cerebrovascular disease, and (2) the complications from CKD including kidney disease progression, cardiovascular disease, CKD mineral and bone disorders, anaemia, quality-of-life, cancer and mortality. This mapping can be used to guide future research.
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Affiliation(s)
- Melanie L R Wyld
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia.
| | - Nicole L De La Mata
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ramyasuda Swaminathan
- Department of Nephrology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Kim M O'Sullivan
- Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Emma O'Lone
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Matthew Rowlandson
- Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia
| | - Anna Francis
- Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Wyburn
- Department of Renal Medicine,Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia
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Sun L, Li Q, Sun Z, Duan S, Nie G, Dong J, Zhang C, Zeng M, Sun B, Yuan Y, Wang N, Mao H, Xing C, Zhang B. Impact of Overhydration on Left Ventricular Hypertrophy in Patients With Chronic Kidney Disease. Front Nutr 2022; 9:761848. [PMID: 35284436 PMCID: PMC8916701 DOI: 10.3389/fnut.2022.761848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveVolume overload is a frequent feature related to left ventricular hypertrophy (LVH) in dialysis patients, but its influence on patients with chronic kidney disease (CKD) not on dialysis has not been accurately uncovered. This article was to examine the relationship between overhydration (OH) and LVH in patients with CKD not yet on dialysis.MethodsA total of 302 patients with CKD stages 1–4 were included. Participants were divided into different subgroups according to occurring LVH or not, and OH tertiles. Clinical and laboratory parameters were compared among groups. Spearman correlation analyses were adopted to explore the relationships of echocardiographic findings with the clinical and laboratory characteristics. Binary logistic regression models were performed to estimate the odds ratios (ORs) for the associations between OH and LVH. Restricted cubic splines were implemented to assess the possible non-linear relationship between OH and LVH. LVH was defined as left ventricular mass index (LVMI) >115 g/m2 in men and >95 g/m2 in women.ResultsOf the enrolled patients with CKD, the mean age was 45.03 ± 15.14 years old, 165 (54.6%) cases were men, and 65 (21.5%) cases had LVH. Spearman correlation analyses revealed that OH was positively correlated with LVMI (r = 0.263, P < 0.001). After adjustment for age, gender, diabetes, body mass index (BMI), systolic blood pressure (SBP), hemoglobin, serum albumin, estimated glomerular filtration rate (eGFR), and logarithmic transformation of urinary sodium and urinary protein, multivariate logistic regression analyses demonstrated that both the middle and highest tertile of OH was associated with increased odds of LVH [OR: 3.082 (1.170–8.114), P = 0.023; OR: 4.481 (1.332–15.078), P = 0.015, respectively], in comparison to the lowest tierce. Restricted cubic spline analyses were employed to investigate the relationship between OH and LVH, which unfolded a significant non-linear association (P for non-linear = 0.0363). Furthermore, patients were divided into two groups according to CKD stages. The multivariate logistic regression analyses uncovered that increased odds of LVH were observed in the middle and the highest tertile of OH [OR: 3.908 (0.975–15.670), P = 0.054; OR: 6.347 (1.257–32.054), P = 0.025, respectively] in patients with stages 1–2.ConclusionThese findings suggest that a higher level of OH was associated with a higher occurrence of LVH in patients with CKD not on dialysis, especially in patients with CKD stages 1–2.
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Impact of Sex and Obesity on Echocardiographic Parameters in Children and Adolescents. Pediatr Cardiol 2022; 43:1502-1516. [PMID: 35394150 PMCID: PMC9489563 DOI: 10.1007/s00246-022-02876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 12/04/2022]
Abstract
Subclinical alterations in left ventricular structure and function are detectable in adolescents with hypertension or obesity. However, data on early echocardiographic abnormalities in seemingly healthy children are lacking. Sex differences in cardiac structure and function have been previously reported, but sex-specific reference values are not available. Specifically, the potential interaction of sex and overweight has not been addressed at all. Anthropometric data, blood pressure and exercise tests were obtained in 356 healthy children. Echocardiographic parameters comprised peak early (E) and late (A) mitral inflow Doppler velocities, E/A ratio, tissue Doppler peak velocities of early (e') and late diastolic (a') excursion of mitral/septal annulus and isovolumetric relaxation time (IVRT). Left ventricular mass index (LVMI) and LVMI z-score were calculated. Interaction terms between BMI and sex and stratification by sex were used for analysis. We provide values for echocardiographic parameters for children of two age groups separated by BMI. Overweight/obese children had a significant higher LVMI, lower E/A ratio, higher E/e' ratios and a longer IVRT. For a given BMI in the upper ranges we demonstrated a higher LVMI in girls than in boys, the IVRT extended significantly more in girls than in boys with increasing BMI. There are sex differences in structural and functional echocardiographic parameters in children and adolescents. Our data not only confirms the importance of overweight and obesity, but demonstrates important interactions between sex and overweight. The greater susceptibility of overweight girls toward echocardiographic changes associated with potential long-term functional impairment needs further exploration and follow-up.Trial registration number DRKS00012371; Date 18.08.2017.
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Bakhoum CY, Katz R, Samuels JA, Al-Rousan T, Furth SL, Ix JH, Garimella PS. Nocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort. Clin J Am Soc Nephrol 2022; 17:75-82. [PMID: 34772729 PMCID: PMC8763165 DOI: 10.2215/cjn.09810721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The physiologic nocturnal BP decline is often blunted in patients with CKD; however, the consequences of BP nondipping in children are largely unknown. Our objective was to determine risk factors for nondipping and to investigate if nondipping is associated with higher left ventricular mass index in children with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a cross-sectional analysis of ambulatory BP monitoring and echocardiographic data in participants of the Chronic Kidney Disease in Children study. Multivariable linear and spline regression analyses were used to evaluate the relationship of risk factors with dipping and of dipping with left ventricular mass index. RESULTS Within 552 participants, mean age was 11 (±4) years, mean eGFR was 53 (±20) ml/min per 1.73 m2, and 41% were classified as nondippers. In participants with nonglomerular CKD, female sex and higher sodium intake were significantly associated with less systolic and diastolic dipping (P≤0.05). In those with glomerular CKD, Black race and greater proteinuria were significantly associated with less systolic and diastolic dipping (P≤0.05). Systolic dipping and diastolic dipping were not significantly associated with left ventricular mass index; however, in spline regression plots, diastolic dipping appeared to have a nonlinear relationship with left ventricular mass index. As compared with diastolic dipping of 20%-25%, dipping of <20% was associated with 1.41-g/m2.7-higher left ventricular mass index (95% confidence interval, -0.47 to 3.29), and dipping of >25% was associated with 1.98-g/m2.7-higher left ventricular mass index (95% confidence interval, -0.77 to 4.73), although these relationships did not achieve statistical significance. CONCLUSIONS Black race, female sex, and greater proteinuria and sodium intake were significantly associated with blunted dipping in children with CKD. We did not find a statistically significant association between dipping and left ventricular mass index. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_12_20_CJN09810721.mp3.
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Affiliation(s)
- Christine Y. Bakhoum
- Department of Pediatrics, Section of Pediatric Nephrology, Yale University, New Haven, Connecticut
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Joshua A. Samuels
- Division of Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Tala Al-Rousan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California
| | - 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
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, California
- Nephrology Section, Medicine Service, Veterans Affairs San Diego Healthcare System, La Jolla, California
- Kidney Research Innovation Hub of San Diego, La Jolla, California
| | - Pranav S. Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, California
- Kidney Research Innovation Hub of San Diego, La Jolla, California
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Assessment and management of obesity and metabolic syndrome in children with CKD stages 2-5 on dialysis and after kidney transplantation-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2022; 37:1-20. [PMID: 34374836 PMCID: PMC8674169 DOI: 10.1007/s00467-021-05148-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Obesity and metabolic syndrome (O&MS) due to the worldwide obesity epidemic affects children at all stages of chronic kidney disease (CKD) including dialysis and after kidney transplantation. The presence of O&MS in the pediatric CKD population may augment the already increased cardiovascular risk and contribute to the loss of kidney function. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. We present CPRs for the assessment and management of O&MS in children with CKD stages 2-5, on dialysis and after kidney transplantation. We address the risk factors and diagnostic criteria for O&MS and discuss their management focusing on non-pharmacological treatment management, including diet, physical activity, and behavior modification in the context of age and CKD stage. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.
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30
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Obesity in Children with Kidney Disease. CURRENT PEDIATRICS REPORTS 2021. [DOI: 10.1007/s40124-021-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Incidence of and risk factors for short stature in children with chronic kidney disease: results from the KNOW-Ped CKD. Pediatr Nephrol 2021; 36:2857-2864. [PMID: 33786659 DOI: 10.1007/s00467-021-05054-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preserving optimal growth has long been a significant concern for children with chronic kidney disease (CKD). We aimed to examine the incidence of and risk factors for short stature in Asian pediatric patients with CKD. METHODS We analyzed growth status by height, weight, and body mass index (BMI) standard deviation scores (SDSs) for 432 participants in the KoreaN cohort study for Outcome in patients With Pediatric Chronic Kidney Disease. RESULTS The median height, weight, and BMI SDSs were - 0.94 (interquartile range (IQR) - 1.95 to 0.05), - 0.58 (IQR - 1.46 to 0.48), and - 0.26 (IQR - 1.13 to 0.61), respectively. A high prevalence of short stature (101 of 432 patients, 23.4%) and underweight (61 of 432 patients, 14.1%) was observed. In multivariable logistic regression analysis, CKD stages 4 and 5 (adjusted odds ratio (aOR) 2.700, p = 0.001), onset before age 2 (aOR 2.928, p < 0.0001), underweight (aOR 2.353, p = 0.013), premature birth (aOR 3.484, p < 0.0001), LBW (aOR 3.496, p = 0.001), and low household income (aOR 1.935, p = 0.030) were independent risk factors associated with short stature in children with CKD. CONCLUSIONS Children with CKD in Korea were shorter and had lower body weight and BMI than the general population. Short stature in children with CKD was most independently associated with low birth weight, followed by premature birth, onset before age 2, CKD stages 4 and 5, underweight, and low household income. Among these, underweight is the only modifiable factor. Therefore, we suggest children with CKD should be carefully monitored for weight, nutritional status, and body composition to achieve optimal growth.
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Abstract
Over the past 2 decades, cardiovascular (CV) disease has been recognized as one of the most important complications of chronic kidney disease (CKD) and one of the leading causes of death in children with advanced CKD and in young adults who developed CKD during childhood. CV abnormalities develop early and progress during the course of CKD in children. Characterization of the prevalence and evolution of CV disease risk factors in progressive CKD is one of the primary aims of the Chronic Kidney Disease in Children study. In this review, we summarize up-to-date findings from the Chronic Kidney Disease in Children study with a focus on traditional and CKD-related CV risk factors and early subclinical markers of cardiac and vascular structure and function. We also discuss the effect of CV risk factors on progression of CKD.
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Affiliation(s)
- Mark M Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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33
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Querfeld U. Cardiovascular disease in childhood and adolescence: Lessons from children with chronic kidney disease. Acta Paediatr 2021; 110:1125-1131. [PMID: 33080082 DOI: 10.1111/apa.15630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Children suffering from chronic kidney disease (CKD) have the apparent highest risk for the development of cardiovascular disease (CVD) at a young age. While symptoms of CVD are characteristically absent in childhood and adolescence, remodelling of the myocardium, medium and large-sized arteries and of the microcirculation is clinically significant and can be assessed with non-invasive technology. Kidney disease and its progression are the driver of CVD, mediated by an unparalleled accumulation of risk factors converging on several comorbid conditions including hypertension, anaemia, dyslipidaemia, disturbed mineral metabolism and chronic persistent inflammation. Large prospective paediatric cohorts studies have provided valuable insights into the pathogenesis and the progression of CKD-induced cardiovascular comorbidity and have characterised the cardiovascular phenotype in young patients. They have also provided the rationale for close monitoring of risk factors and have defined therapeutic targets. Recently discovered new biomarkers could help identify the individual risk for CVD. Prevention of CVD by aggressive therapy of modifiable risk factors is essential to enable long-term survival of young patients with CKD.
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Affiliation(s)
- Uwe Querfeld
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in children with chronic kidney disease (CKD). The cause of CVD in children with CKD is multifactorial and there are new and emerging data regarding prevalence and risk factors for CVD in this population. RECENT FINDINGS A number of recent publications from longitudinal cohort studies of children with CKD have greatly increased our knowledge about the prevalence and risk factors for CVD including hypertension, obesity and dyslipidaemia. Masked hypertension and isolated nocturnal hypertension both correlate with surrogate markers of CVD in children. Obesity and adiposity are associated with an increased risk of CVD. Markers other than BMI such as waist to height ratio and fat-free tissue to fat tissue ratio better correlate with the presence of CVD in children. Dyslipidaemia is extremely prevalent in the paediatric CKD population, but there is a lack of consensus on treatment. More data on the relationship between bone mineral disease and CVD continue to emerge including an association between hyperparathyroidism and isolated nocturnal hypertension. SUMMARY Children with CKD have multiple potentially modifiable risk factors for CVD. Research focused on CVD outcomes in children is needed.
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Sgambat K, Moudgil A. Obesity and Cardiovascular Outcomes in Children With CKD: Does Sex Matter? Am J Kidney Dis 2020; 76:161-162. [PMID: 32389355 DOI: 10.1053/j.ajkd.2020.02.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Kristen Sgambat
- Division of Nephrology, Children's National Hospital, Washington, DC.
| | - Asha Moudgil
- Division of Nephrology, Children's National Hospital, Washington, DC
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