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Grabitz C, Sugianto RI, Doyon A, Azukaitis K, Anarat A, Bacchetta J, Bayazit AK, Bulut IK, Caliskan S, Canpolat N, Duzova A, Habbig S, Harambat J, Kiyak A, Longo G, Obrycki L, Paripovic D, Söylemezoğlu O, Thurn-Valsassina D, Yilmaz A, Shroff R, Schaefer F, Schmidt BMW, Melk A. Long-term Effects of Kidney Transplantation Compared With Dialysis on Intima-media Thickness in Children-Results From the 4C-T Study. Transplantation 2024; 108:1212-1219. [PMID: 38227773 DOI: 10.1097/tp.0000000000004881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Children requiring kidney replacement therapy experience high burden of cardiovascular (CV) disease leading to increased mortality. Intima-media thickness (IMT) indicating atherosclerosis is a validated surrogate marker for future CV events. METHODS We investigated the effect of different treatment modalities (dialysis, preemptive kidney transplantation (KTx), late KTx after dialysis) on IMT by multivariable linear mixed-effect modeling. Patients were enrolled in a prospective cohort study. RESULTS A total of 261 analyzed children had a mean follow-up of 3 y. Children after preemptive and late KTx had lower levels of IMT when compared with dialysis. Using an interaction term, a significant progression of IMT over time was seen during dialysis (β = 0.0053 mm/y, P = 0.004). IMT before the start of therapy was the most influential determinant in all models. Low IMT was associated with maintenance steroid treatment after preemptive KTx. High IMT on dialysis was associated with higher systolic blood pressure, lower body mass index, lower serum albumin, and lower bicarbonate. CONCLUSIONS IMT remained rather stable in children several years after KTx. In contrast, children on dialysis had higher IMT values, which increased over time. In these children, blood pressure control, calorie and protein intake, and acid-base homeostasis seem important. Taken together, children might profit from early transplantation to limit accumulation of CV risk.
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Affiliation(s)
- Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Rizky I Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Anke Doyon
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ali Anarat
- Department of Pediatrics, Faculty of Medicine, Cukurova Universitesi, Adana, Turkiye
| | | | - Aysun K Bayazit
- Department of Pediatrics, Faculty of Medicine, Cukurova Universitesi, Adana, Turkiye
| | - Ipek K Bulut
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkiye
| | - Salim Caliskan
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkiye
| | - Nur Canpolat
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkiye
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Sandra Habbig
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jerome Harambat
- Department of Pediatrics, Nephrology Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Aysel Kiyak
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkiye
| | - Germana Longo
- Department of Women's and Children's Health, University of Padua, Padova, Veneto, Italy
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dusan Paripovic
- Department of Nephrology, Children's Hospital, University of Belgrade, Belgrade, Serbia
| | - Oğuz Söylemezoğlu
- Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkiye
| | - Daniela Thurn-Valsassina
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Alev Yilmaz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, United Kingdom
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Bernhard M W Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Sugianto RI, Ostendorf K, Bauer E, von der Born J, Oh J, Kemper MJ, Buescher R, Schmidt BMW, Memaran N, Melk A. Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients. Pediatr Nephrol 2023; 38:1319-1327. [PMID: 36094669 PMCID: PMC9925540 DOI: 10.1007/s00467-022-05611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulse wave velocity (PWV) is a measure of arterial stiffness. We investigated PWV and blood pressure (BP) to determine to what extent BP changes contribute to arterial stiffness, and secondly, to identify influencing factors on BP in children after kidney transplantation. METHODS Seventy children ≥ 2.5 years post-transplantation with at least two PWV measurements were included. Changes of systolic (Δ SBP) and diastolic BP (Δ DBP) were classified into "stable/decreasing," "1-10 mmHg increase," and " > 10 mmHg increase." Linear mixed modeling for PWV z-score (PWVz) adjusted either for Δ SBP or Δ DBP was performed. An extended dataset with monthly entries of BP, immunosuppression, and creatinine was obtained in 35 participants over a median of 74 months to perform linear mixed modeling for SBP and DBP. RESULTS PWVz increased with a rate of 0.11/year (95% CI 0.054 to 0.16). Compared to participants with stable BP, those with 1-10-mmHg SBP and DBP increase showed a higher PWVz of 0.59 (95% CI 0.046 to 1.13) and 0.86 (95% CI 0.43 to 1.30), respectively. A > 10-mmHg BP increase was associated with an even higher PWVz (SBP β = 0.78, 95% CI 0.22 to 1.34; DBP β = 1.37, 95% CI 0.80 to 1.94). Female sex and participants with lower eGFR showed higher PWVz. In the extended analysis, DBP was positively associated with cyclosporin A and everolimus trough levels. CONCLUSIONS A higher increase of PWV is seen in patients with greater BP increase, with higher cyclosporin A and everolimus trough levels associated with higher BP. This emphasizes the role of BP as a modifiable risk factor for the improvement of cardiovascular outcome after transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rizky Indrameikha Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Karen Ostendorf
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Elena Bauer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J Kemper
- Department of Pediatrics and Adolescent Medicine, Asklepios Hospital Nord-Heidberg, Hamburg, Germany
| | - Rainer Buescher
- University Children's Hospital, Essen University Hospital, Essen, Germany
| | - Bernhard M W Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Lalayiannis AD, Ferro CJ, Wheeler DC, Duncan ND, Smith C, Popoola J, Askiti V, Mitsioni A, Kaur A, Sinha MD, McGuirk SP, Mortensen KH, Milford DV, Shroff R. The burden of subclinical cardiovascular disease in children and young adults with chronic kidney disease and on dialysis. Clin Kidney J 2022; 15:287-294. [PMID: 35145643 PMCID: PMC8824782 DOI: 10.1093/ckj/sfab168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a common cause of morbidity and mortality even in young
people with chronic kidney disease (CKD). We examined structural and functional CV
changes in patients ˂30 years of age with CKD Stages 4 and 5 and on dialysis. Methods A total of 79 children and 21 young adults underwent cardiac computed tomography for
coronary artery calcification (CAC), ultrasound for carotid intima-media thickness
(cIMT), carotid–femoral pulse wave velocity (cfPWV) and echocardiography. Differences in
structural (CAC, cIMT z-score, left ventricular mass index) and
functional (carotid distensibility z-score and cfPWV
z-score) measures were examined between CKD Stages 4 and 5 and dialysis
patients. Results Overall, the cIMT z-score was elevated [median 2.17 (interquartile
range 1.14–2.86)] and 10 (10%) had CAC. A total of 16/23 (69.5%) patients with CKD
Stages 4 and 5 and 68/77 (88.3%) on dialysis had at least one structural or functional
CV abnormality. There was no difference in the prevalence of structural abnormalities in
CKD or dialysis cohorts, but functional abnormalities were more prevalent in patients on
dialysis (P < 0.05). The presence of more than one structural abnormality was
associated with a 4.5-fold increased odds of more than one functional abnormality (95%
confidence interval 1.3–16.6; P < 0.05). Patients with structural and functional
abnormalities [cIMT z-score >2 standard deviation (SD) or
distensibility <−2 SD) had less carotid dilatation (lumen:wall cross-sectional area
ratio) compared with those with normal cIMT and distensibility. Conclusions There is a high burden of subclinical CVD in young CKD patients, with a greater
prevalence of functional abnormalities in dialysis compared with CKD patients.
Longitudinal studies are required to test these hypothesis-generating data and define
the trajectory of CV changes in CKD.
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Affiliation(s)
- Alexander D Lalayiannis
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Charles J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Neill D Duncan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Colette Smith
- Institute of Global Health, University College London, London, UK
| | - Joyce Popoola
- Department of Nephrology and Transplantation, St. George's University Hospital NHS Foundation Trust, London, UK
| | | | | | - Amrit Kaur
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Manish D Sinha
- Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Simon P McGuirk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kristian H Mortensen
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - David V Milford
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
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Filip C, Cirstoveanu C, Bizubac M, Berghea EC, Căpitănescu A, Bălgrădean M, Pavelescu C, Nicolescu A, Ionescu MD. Pulse Wave Velocity as a Marker of Vascular Dysfunction and Its Correlation with Cardiac Disease in Children with End-Stage Renal Disease (ESRD). Diagnostics (Basel) 2021; 12:diagnostics12010071. [PMID: 35054238 PMCID: PMC8774385 DOI: 10.3390/diagnostics12010071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022] Open
Abstract
One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.
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Affiliation(s)
- Cristina Filip
- Pediatric Cardiology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.F.); (A.N.)
| | - Cătălin Cirstoveanu
- Neonatal Intensive Care Unit, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Correspondence:
| | - Mihaela Bizubac
- Neonatal Intensive Care Unit, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Elena Camelia Berghea
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.B.); (M.B.)
- Allergology and Clinical Immunology Department, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
| | - Andrei Căpitănescu
- Pediatric Hemodialysis, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Mihaela Bălgrădean
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.B.); (M.B.)
- Pediatrics and Pediatric Nephrology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Carmen Pavelescu
- Pediatrics and Pediatric Nephrology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Alin Nicolescu
- Pediatric Cardiology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.F.); (A.N.)
| | - Marcela Daniela Ionescu
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Pediatrics and Pediatric Pulmonology, M.S. Curie Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania
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Azukaitis K, Jankauskiene A, Schaefer F, Shroff R. Pathophysiology and consequences of arterial stiffness in children with chronic kidney disease. Pediatr Nephrol 2021; 36:1683-1695. [PMID: 32894349 DOI: 10.1007/s00467-020-04732-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
Changes in arterial structure and function are seen early in the course of chronic kidney disease (CKD) and have been causally associated with cardiovascular (CV) morbidity. Numerous potential injuries encompassing both traditional and uremia-specific CV risk factors can induce structural arterial changes and accelerate arterial stiffening. When the buffering capacity of the normally elastic arteries is reduced, damage to vulnerable microcirculatory beds can occur. Moreover, the resultant increase to cardiac afterload contributes to the development of left ventricular hypertrophy and cardiac dysfunction. Adult studies have linked arterial stiffness with increased risk of mortality, CV events, cognitive decline, and CKD progression. Pulse wave velocity (PWV) is currently the gold standard of arterial stiffness assessment but its measurement in children is challenging due to technical difficulties and physiologic aspects related to growth and poor standardization between algorithms for calculating PWV. Nevertheless, studies in pediatric CKD have reported increased arterial stiffness in children with advanced CKD, on dialysis, and after kidney transplantation. Development of arterial stiffness in children with CKD is closely related to mineral-bone disease and hypertension, but other factors may also play a significant role. The clinical relevance of accelerated arterial stiffness in childhood on cardiovascular outcomes in adult life remains unclear, and prospective studies are needed. In this review we discuss mechanisms leading to arterial stiffness in CKD and its clinical implications, along with issues surrounding the technical aspects of arterial stiffness assessment in children.
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Affiliation(s)
- Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 4, 08406, Vilnius, Lithuania.
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 4, 08406, Vilnius, Lithuania
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Institute of Child Health, London, UK
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Kruger R, Gafane-Matemane LF, Kagura J. Racial differences of early vascular aging in children and adolescents. Pediatr Nephrol 2021; 36:1087-1108. [PMID: 32444927 DOI: 10.1007/s00467-020-04593-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
The prevalence of non-communicable disease (NCDs) is rising globally, with a large burden recorded in sub-Saharan countries and populations of black race/ethnicity. Accelerated vascular deterioration, otherwise known as early vascular aging (EVA), is the underlying factor for highly prevalent NCDs such as hypertension. The etiology of EVA is multifactorial with a central component being arterial stiffness with subsequent development of hypertension and cardiovascular complications. Although arterial stiffness develops with increasing age, many children and adolescents are subjected to the premature development of arterial stiffness, due to genetic or epigenetic predispositions, lifestyle and behavioral risk factors, and early life programming. Race/ethnic differences in pediatric populations have also been reported with higher aortic stiffness in black (African American) compared with age-matched white (European American) counterparts independent of blood pressure, body mass index, or socioeconomic status. With known evidence of race/ethnic differences in EVA, the pathophysiological mechanisms underlying graded differences in the programming of EVA are still sparse and rarely explored. This educational review aims to address the early life determinants of EVA in children and adolescents with a particular focus on racial or ethnic differences.
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Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Lebo Francina Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Ambulatory blood pressures and central blood pressures are associated with cardiovascular morbidity in adolescent and young adult patients receiving chronic hemodialysis. Pediatr Nephrol 2019; 34:1261-1268. [PMID: 30778828 DOI: 10.1007/s00467-019-04208-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/16/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) and arterial stiffness measured by pulse wave velocity (PWV) are independent predictors of cardiovascular (CV) mortality in adults receiving chronic dialysis. Hypertension strongly associates with elevated left ventricular mass index (LVMI) and PWV, with ambulatory blood pressure monitoring (ABPM), and central blood pressure (CBP) superior to office blood pressures (BP) in predicting CV morbidity. Few studies have described associations of office BP, ABPM, and CBP with LVMI and PWV in adolescent and young adult patients receiving hemodialysis (HD). METHODS Cross-sectional study of 22 adolescents and young adults receiving chronic HD. Pre- and post-dialysis office BP and CBP using applanation tonometry were obtained. Twenty-four-hour ABPM was obtained midweek post-dialysis. Pre- and post-dialysis carotid-brachial PWV were obtained same day as BP measurements. Annual echocardiograms for standard care were reviewed for LVH. RESULTS Pre-dialysis CBP index correlated with LVMI (r = 0.3, p = 0.04) and PWV (r = 0.48, p = 0.02). Hypertensive patients identified by ABPM had worse LVMI; daytime ABPM systolic BP index correlated with LVMI (r = 0.5, p = 0.02). Office BP was not associated with LVMI; only office diastolic BP was associated with PWV (r = 0.46, p = 0.02). There was no correlation of LVMI or PWV with bone health parameters, anemia, interdialytic weight gain, or residual renal function. CONCLUSIONS Ambulatory blood pressure monitoring is superior to casual office BP obtained at time of dialysis in delineating cardiovascular morbidity in adolescent and young adult HD patients. CBP is easily performed and correlates with LVMI and PWV in adolescent and young adult HD patients; however, large-scale normative data is needed.
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Early Effects of Renal Replacement Therapy on Cardiovascular Comorbidity in Children With End-Stage Kidney Disease: Findings From the 4C-T Study. Transplantation 2018; 102:484-492. [PMID: 28926375 DOI: 10.1097/tp.0000000000001948] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. METHODS We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). RESULTS RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ß = -0.67; P < 0.001) and intima media thickness (ß = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ß = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ß = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ß = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ß = 1.47; P = 0.01). CONCLUSIONS In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.
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Khoury M, Urbina EM. Cardiac and Vascular Target Organ Damage in Pediatric Hypertension. Front Pediatr 2018; 6:148. [PMID: 29881718 PMCID: PMC5976785 DOI: 10.3389/fped.2018.00148] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.
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Affiliation(s)
| | - Elaine M. Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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10
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Sgambat K, Clauss S, Moudgil A. Cardiovascular effects of metabolic syndrome after transplantation: convergence of obesity and transplant-related factors. Clin Kidney J 2017; 11:136-146. [PMID: 29423213 PMCID: PMC5798023 DOI: 10.1093/ckj/sfx056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022] Open
Abstract
Children are at increased risk of developing metabolic syndrome (MS) after kidney transplantation, which contributes to long-term cardiovascular (CV) morbidities and decline in allograft function. While MS in the general population occurs due to excess caloric intake and physical inactivity, additional chronic kidney disease and transplant-related factors contribute to the development of MS in transplant recipients. Despite its significant health consequences, the interplay of the individual components in CV morbidity in pediatric transplant recipients is not well understood. Additionally, the optimal methods to detect early CV dysfunction are not well defined in this unique population. The quest to establish clear guidelines for diagnosis is further complicated by genetic differences among ethnic groups that necessitate the development of race-specific criteria, particularly with regard to individuals of African descent who carry the apolipoprotein L1 variant. In children, since major CV events are rare and traditional echocardiographic measures of systolic function, such as ejection fraction, are typically well preserved, the presence of CV disease often goes undetected in the early stages. Recently, new noninvasive imaging techniques have become available that offer the opportunity for early detection. Carotid intima-media thickness and impaired myocardial strain detected by speckle tracking echocardiography or cardiac magnetic resonance are emerging as early and sensitive markers of subclinical CV dysfunction. These highly sensitive tools may offer the opportunity to elucidate subtle CV effects of MS in children after transplantation. Current knowledge and future directions are explored in this review.
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Affiliation(s)
- Kristen Sgambat
- Department of Nephrology, Children's National Medical Center, Washington, DC, USA
| | - Sarah Clauss
- Department of Cardiology, Children's National Medical center, Washington, DC, USA
| | - Asha Moudgil
- Department of Nephrology, Children's National Medical Center, Washington, DC, USA
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Ghigolea AB, Gherman-Caprioara M, Moldovan AR. Arterial stiffness: hemodialysis versus hemodiafiltration. Med Pharm Rep 2017; 90:166-170. [PMID: 28559700 PMCID: PMC5433568 DOI: 10.15386/cjmed-699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 11/23/2022] Open
Abstract
Background and aims Arterial stiffness seems to be influenced by the dialysis method, but studies are sparse and the results discordant. High substitution volume online hemodiafiltration appears to have beneficial cardiovascular effects in dialysis patients, but its effects on arterial stiffness are not investigated. We aimed to analyze arterial stiffness parameters in high substitution volume post-dilution online hemodiafiltration and compare results to high-flux hemodialysis. Methods We studied arterial stiffness parameters using the oscillometric method (Arteriograph IrDA, TensioMed, Budapest, Hungary) in 23 non-diabetic patients on high substitution volume online postdilution hemodiafiltration and 23 non-diabetic patients on high-flux hemodialysis. Dialysis vintage was at least 6 months in all subjects. Results Hemodiafiltration-treated patients showed a more favorable arterial stiffness profile. Pulse wave velocity was significantly higher in hemodialysis compared to hemodiafiltration patients (10.39±2.29 m/s vs 9.0±1.7 m/s, p=0.026). Augmentation indexes and the diastolic reflection area were also significantly elevated hemodialysis patients compared to hemodiafiltration patients. Conclusions High substitution volume online postdilution hemodiafiltration could have a beneficial effect on arterial stiffness and should be assessed in properly sized controlled trials.
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Affiliation(s)
- Adrian-Bogdan Ghigolea
- Nephrology Unit, Alba County Emergency Hospital, Alba-Iulia, Romania.,Nefromed Dialysis Centers, Alba-Iulia, Romania
| | - Mirela Gherman-Caprioara
- Department of Nephrology, Iuliu Hatieganu University of Medicne and Pharmacy, Cluj-Napoca, Romania
| | - Argentina Raluca Moldovan
- Nephrology Unit, Alba County Emergency Hospital, Alba-Iulia, Romania.,Nefromed Dialysis Centers, Alba-Iulia, Romania
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12
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Affiliation(s)
- Luminita Voroneanu
- From the Nephrology Department, Dialysis and Renal Transplant Center, “Dr C.I. Parhon” University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- From the Nephrology Department, Dialysis and Renal Transplant Center, “Dr C.I. Parhon” University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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13
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Kolonko A, Chudek J, Szotowska M, Kuczera P, Wiecek A. Cardiovascular Risk Factors and Markers of Atherosclerosis in Stable Kidney Transplant Recipients. Transplant Proc 2017; 48:1543-50. [PMID: 27496444 DOI: 10.1016/j.transproceed.2015.12.134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/30/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is limited evidence regarding the risk factors influencing vascular injury in kidney transplant recipients, except for accelerated vasculopathy and endothelial dysfunction in the pre-transplantation period of end-stage renal failure. Therefore, we performed a cross-sectional study to evaluate the role of traditional and novel or potential nontraditional risk factors in vascular and endothelial dysfunction in a cohort of stable kidney transplant recipients. METHODS One hundred forty-two kidney transplant recipients at 8.4 ± 1.8 years after transplantation were enrolled into the study. Different markers of vascular injury, such as carotid intima-media thickness (IMT), pulse wave velocity (PWV), and peripheral arterial tonometry (PAT), were assessed. Inflammatory markers, oxidative stress and endothelial function surrogate markers, adhesion molecules, and parathormone and osteoprotegerin levels were measured. RESULTS Among traditional risk factors, only age, pre-transplantation diabetes, left ventricular hypertrophy (LVH) and cardiovascular disease (CVD) were related to increased IMT and PWV, whereas PAT values were significantly decreased only in diabetics and patients with CVD and were similar in patients with and without LVH. In multivariate regression analysis, IMT was explained by age, previous CVD episodes, and higher high-sensitivity C-reactive protein levels, and PWV by age and pre-transplantation diabetes. The regression analysis failed to find any significant explanatory variables for PAT. CONCLUSIONS 1. In stable kidney transplant recipients, age, pre-transplantation diabetes, previous cardiovascular episode, and systemic microinflammation were predictors of vascular injury. 2. PAT is poorly associated with traditional CV risk factors and does not correspond with levels of biochemical markers of endothelial dysfunction in those patients.
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Affiliation(s)
- A Kolonko
- Department of Nephrology, Transplantation, and Internal Medicine, Medical University of Silesia, Katowice, Poland.
| | - J Chudek
- Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - M Szotowska
- Department of Nephrology, Transplantation, and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - P Kuczera
- Department of Nephrology, Transplantation, and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - A Wiecek
- Department of Nephrology, Transplantation, and Internal Medicine, Medical University of Silesia, Katowice, Poland
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14
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Savant JD, Betoko A, Meyers KEC, Mitsnefes M, Flynn JT, Townsend RR, Greenbaum LA, Dart A, Warady B, Furth SL. Vascular Stiffness in Children With Chronic Kidney Disease. Hypertension 2017; 69:863-869. [PMID: 28373588 DOI: 10.1161/hypertensionaha.116.07653] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/12/2016] [Accepted: 02/08/2017] [Indexed: 12/30/2022]
Abstract
Carotid-femoral pulse wave velocity (cfPWV) is a measure of arterial stiffness associated with cardiovascular events in the general population and in adults with chronic kidney disease. However, few data exist regarding cfPWV in children with chronic kidney disease. We compared observed cfPWV assessed via applanation tonometry in children enrolled in the CKiD cohort study (Chronic Kidney Disease in Children) to normative data in healthy children and examined risk factors associated with elevated cfPWV. cfPWV Z score for height/gender and age/gender was calculated from and compared with published pediatric norms. Multivariable linear regression was used to assess the relationship between cfPWV and age, gender, race, body mass index, diagnosis, urine protein-creatinine ratio, mean arterial pressure, heart rate, number of antihypertensive medications, uric acid, and serum low-density lipoprotein. Of the 95 participants with measured cfPWV, 60% were male, 19% were black, 46% had glomerular cause of chronic kidney disease, 22% had urine protein-creatinine ratio 0.5 to 2.0 mg/mg and 9% had >2.0 mg/mg, mean age was 15.1 years, average mean arterial pressure was 80 mm Hg, and median glomerular filtration rate was 63 mL/min per 1.73 m2 Mean cfPWV was 5.0 m/s (SD, 0.8 m/s); mean cfPWV Z score by height/gender norms was -0.1 (SD, 1.1). cfPWV increased significantly with age, mean arterial pressure, and black race in multivariable analysis; no other variables, including glomerular filtration rate, were independently associated with cfPWV. In this pediatric cohort with mild kidney dysfunction, arterial stiffness was comparable to that of normal children. Future research is needed to examine the impact of chronic kidney disease progression on arterial stiffness and associated cardiovascular parameters in children.
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Affiliation(s)
- Jonathan D Savant
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Aisha Betoko
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Kevin E C Meyers
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Mark Mitsnefes
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Joseph T Flynn
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Raymond R Townsend
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Larry A Greenbaum
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Allison Dart
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Bradley Warady
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.)
| | - Susan L Furth
- From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.).
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15
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Abnormalities of vascular structure and function in pediatric hypertension. Pediatr Nephrol 2016; 31:1061-70. [PMID: 26275663 PMCID: PMC4754169 DOI: 10.1007/s00467-015-3188-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/01/2015] [Accepted: 07/27/2015] [Indexed: 12/17/2022]
Abstract
Hypertension is associated with adverse cardiovascular (CV) events in adults. Measures of vascular structure and function, including increased carotid intima-media thickness (cIMT) and elevated arterial stiffness predict hard CV events in adulthood. Newer data suggest that abnormalities in target organ damage are occurring in adolescents and young adults with high blood pressure. In this review, we discuss the techniques for measuring vascular dysfunction in young people and the evidence linking blood pressure levels to this type of target organ damage.
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16
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Al Nasser Y, Moura MC, Mertens L, McCrindle BW, Parekh RS, Ng VL, Church PC, Mouzaki M. Subclinical cardiovascular changes in pediatric solid organ transplant recipients: A systematic review and meta-analysis. Pediatr Transplant 2016; 20:530-9. [PMID: 26890272 DOI: 10.1111/petr.12689] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/28/2022]
Abstract
CV disease is a major cause of morbidity and mortality following solid organ transplantation in adults. While the prevalence of multiple cardiometabolic risk factors is increased in pediatric solid organ transplant recipients, it is not clear whether they have subclinical CV changes. cIMT, central pWV, and CAC are indicative of subclinical CV disease, and, in adults, predict future CV events. The objective of this systematic review and meta-analysis was to investigate the prevalence of subclinical CV changes, as measured by cIMT, pWV, and CAC among pediatric solid organ transplant recipients. We searched MEDLINE(®) and EMBASE and conducted meta-analysis for studies that evaluated cIMT, central pWV, and CAC among pediatric solid organ transplant recipients (kidney, lung, intestine and liver). The search identified nine eligible studies that included a total of 259 patients and 685 healthy controls. Eight studies reported on kidney transplant recipients and one study on a combined cohort of kidney and liver transplant recipients. The mean cIMT of transplant recipients was significantly higher than that of healthy controls (mean difference = 0.05 mm, 95% CI 0.02-0.07; p < 0.0001) with an estimated pooled prevalence of elevated cIMT of 56.0% (95% CI 17.0-95.0). The one study that assessed pWV showed increased vascular stiffness in transplant recipients compared to healthy controls. No studies assessing for CAC were found. There were limited data regarding subclinical CV disease following pediatric solid organ transplantation. In conclusion, kidney transplantation in childhood is associated with a higher prevalence of subclinical CV changes compared to healthy children. Longitudinal studies are needed to determine whether children have increased CV morbidity and mortality after transplantation.
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Affiliation(s)
- Yasser Al Nasser
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marta C Moura
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Luc Mertens
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Brian W McCrindle
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan S Parekh
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.,SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter C Church
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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17
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Ali A, Macphee I, Kaski JC, Banerjee D. Cardiac and vascular changes with kidney transplantation. Indian J Nephrol 2016; 26:1-9. [PMID: 26937071 PMCID: PMC4753734 DOI: 10.4103/0971-4065.165003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular event rates are high in patients with chronic kidney disease (CKD), increasing with deteriorating kidney function, highest in CKD patients on dialysis, and improve with kidney transplantation (KTx). The cardiovascular events in CKD patients such as myocardial infarction and heart failure are related to abnormalities of vascular and cardiac structure and function. Many studies have investigated the structural and functional abnormalities of the heart and blood vessels in CKD, and the changes that occur with KTx, but the evidence is often sparse and occasionally contradictory. We have reviewed the available evidence and identified areas where more research is required to improve the understanding and mechanisms of these changes. There is enough evidence demonstrating improvement of left ventricular hypertrophy, except in children, and sufficient evidence of improvement of left ventricular function, with KTx. There is reasonable evidence of improvement in vascular function and stiffness. However, the evidence for improvement of vascular structure and atherosclerosis is insufficient. Further studies are necessary to establish the changes in vascular structure, and to understand the mechanisms of vascular and cardiac changes, following KTx.
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Affiliation(s)
- A Ali
- Renal and Transplantation Unit, St. George's University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, UK
| | - I Macphee
- Renal and Transplantation Unit, St. George's University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, UK
| | - J C Kaski
- Division of Clinical Sciences, Cardiovascular and Cell Sciences Research Institute, St George's University of London, Tooting, London SW17 0RE, UK
| | - D Banerjee
- Renal and Transplantation Unit, St. George's University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, UK; Division of Clinical Sciences, Cardiovascular and Cell Sciences Research Institute, St George's University of London, Tooting, London SW17 0RE, UK
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18
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Savant JD, Furth SL, Meyers KE. Arterial Stiffness in Children: Pediatric Measurement and Considerations. Pulse (Basel) 2014; 2:69-80. [PMID: 26587447 PMCID: PMC4646130 DOI: 10.1159/000374095] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arterial stiffness is a natural consequence of aging, accelerated in certain chronic conditions, and predictive of cardiovascular events in adults. Emerging research suggests the importance of arterial stiffness in pediatric populations. METHODS There are different indices of arterial stiffness. The present manuscript focuses on carotid-femoral pulse wave velocity and pulse wave analysis, although other methodologies are discussed. Also reviewed are specific measurement considerations for pediatric populations and the literature describing arterial stiffness in children with certain chronic conditions (primary hypertension, obesity, diabetes, chronic kidney disease, hypercholesterolemia, genetic syndromes involving vasculopathy, and solid organ transplant recipients). CONCLUSIONS The measurement of arterial stiffness in children is feasible and, under controlled conditions, can give accurate information about the underlying state of the arteries. This potentially adds valuable information about the functionality of the cardiovascular system in children with a variety of chronic diseases well beyond that of the brachial artery blood pressure.
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Affiliation(s)
- Jonathan D. Savant
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
| | - Susan L. Furth
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
- Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa., USA
| | - Kevin E.C. Meyers
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
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