Adiponectin Levels and Atherosclerotic Risk Factors in Pediatric Chronic Peritoneal Dialysis Patients

Background

Atherosclerotic vascular diseases are the major cause of mortality in patients with end-stage renal disease (ESRD) treated with chronic peritoneal dialysis (CPD), even in children. Adiponectin (ADPN) is a recently discovered adipocyte-derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death.

Objective

To clarify the atherosclerotic risk and especially the significance of ADPN levels in pediatric patients on CPD.

Design

Cross-sectional study in the pediatric peritoneal dialysis unit of a university hospital.

Patients

18 children, aged 12.6 ± 5.6 years, being treated with CPD and 20 healthy age- and sex-matched control subjects were enrolled in this study.

Methods

Serum ADPN levels and other risk factors, including blood pressure, blood glucose, serum lipid/lipoprotein fractions, apolipoprotein B, C-reactive protein (CRP), lipoprotein(a), and homocysteine levels, were studied in CPD patients and compared to the controls.

Results

Serum ADPN levels were three times higher in the CPD group compared to the control subjects, as was previously reported. Apolipoprotein B and CRP levels were also high in the CPD group. No significant difference was found in other atherosclerotic parameters, including lipoprotein(a) and homocysteine levels. Interestingly, we found a negative correlation between log ADPN and creatinine levels among the CPD patients ( r = –0.54, p < 0.05). There was no correlation between log ADPN and duration of CPD. Creatinine and low-density lipoprotein levels could account for 54% of the total variation in ADPN levels.

Conclusion

Among pediatric CPD patients, serum levels of the anti-atherogenic protein, ADPN, were inversely associated with creatinine. ADPN level might be a novel marker to predict prognosis in pediatric CPD patients.

Noninfectious Complications of Peritoneal Dialysis in Korean Children: A 26-Year Single-Center Study

PURPOSE

The aim of this study was to investigate noninfectious complications of peritoneal dialysis (PD), including mechanical and metabolic complications, at a single center in Korea.

MATERIALS AND METHODS

We analyzed data from 60 PD patients aged ≤18 years (40 boys and 20 girls) during the period between 1986 and 2012. The collected data included gender, age, causes of PD, incidence of noninfectious complications, and treatment for the complications.

RESULTS

The mean duration of PD therapy was 28.7±42.1 months (range 1-240 months). The most common cause of end-stage renal disease was glomerular disease (43.3%). There were no statistically significant differences between patients with and without mechanical complications regarding gender, age at the start of PD, and total duration of PD. Outflow failure was the most common catheter-related complication (14.3%), followed by leakage (10.0%) and hernia (8.6%). Metabolic complications, such as hyperglycemia and hypokalemia, were observed in three of 16 patients. The frequency of noninfectious complications of PD in our study was comparable with those in previous pediatric studies. PD was switched to hemodialysis (HD) in only three patients.

CONCLUSION

Our results indicate that noninfectious complications of PD are common, though they hardly lead to catheter removal or HD in pediatric patients on PD.

Chronic kidney disease in children: the global perspective

In contrast to the increasing availability of information pertaining to the care of children with chronic kidney disease (CKD) from large-scale observational and interventional studies, epidemiological information on the incidence and prevalence of pediatric CKD is currently limited, imprecise, and flawed by methodological differences between the various data sources. There are distinct geographic differences in the reported causes of CKD in children, in part due to environmental, racial, genetic, and cultural (consanguinity) differences. However, a substantial percentage of children develop CKD early in life, with congenital renal disorders such as obstructive uropathy and aplasia/hypoplasia/dysplasia being responsible for almost one half of all cases. The most favored end-stage renal disease (ESRD) treatment modality in children is renal transplantation, but a lack of health care resources and high patient mortality in the developing world limits the global provision of renal replacement therapy (RRT) and influences patient prevalence. Additional efforts to define the epidemiology of pediatric CKD worldwide are necessary if a better understanding of the full extent of the problem, areas for study, and the potential impact of intervention is desired.

Epidemiology of pediatric chronic kidney disease

In contrast to the adult population, in whom a variety of registries have confirmed the incidence, prevalence, and diagnoses associated with chronic kidney disease (CKD), the epidemiological information on pediatric CKD is currently imprecise and flawed by methodological differences between the various data sources. Obstructive uropathy and congenital aplasia/hypoplasia/dysplasia are responsible for almost one half of all cases of CKD in children, underscoring the fact that a substantial percentage of the pediatric CKD population develops renal insufficiency very early in life. However, there are distinct geographic differences in the reported causes of CKD, in part because of environmental, racial, genetic, and cultural (consanguinity) differences. Furthermore, despite apparently comparable incidence rates, high mortality in countries that lack health care resources results in a low prevalence of CKD in those locations. In countries where renal replacement therapy is readily available, the most favored treatment modality is renal transplantation in all pediatric age groups. Additional efforts to define the epidemiology of pediatric CKD worldwide in a more uniform manner are necessary if a better understanding of the full extent of the problem, areas for study, and the potential impact of intervention is desired.

Long-term survival of children with end-stage renal disease

BACKGROUND

Although renal-replacement therapy for children with end-stage renal disease has been used for several decades, data on patients' long-term survival are sparse.

METHODS

We examined the long-term survival of all children and adolescents who were under 20 years of age when renal-replacement therapy commenced (study period, April 1963 through March 2002), using data from the Australia and New Zealand Dialysis and Transplant Registry. Survival was analyzed with the use of Kaplan-Meier methods and age-standardized mortality rates. Risk factors for death were analyzed with the use of Cox regression analysis with time-dependent covariates.

RESULTS

A total of 1634 children and adolescents were followed for a median of 9.7 years. The long-term survival rate among children requiring renal-replacement therapy was 79 percent at 10 years and 66 percent at 20 years. Mortality rates were 30 times as high as for children without end-stage renal disease. Risk factors for death were a young age at the time renal-replacement therapy was initiated (especially for children under 1 year of age, among whom the risk was four times as high as for children 15 to 19 years of age) and treatment with dialysis (which was associated with a risk more than four times as high as for renal transplantation). Overall, a trend toward improved survival was observed over the four decades of the study.

CONCLUSIONS

Despite improvement in long-term survival, mortality rates among children requiring renal-replacement therapy remain substantially higher than those among children without end-stage renal disease. Increasing the proportion of children treated with renal transplantation rather than with dialysis can improve survival further.