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Orlandi M, Masi S, Bhowruth D, Leira Y, Georgiopoulos G, Yellon D, Hingorani A, Chiesa ST, Hausenloy DJ, Deanfield J, D'Aiuto F. Remote Ischemic Preconditioning Protects Against Endothelial Dysfunction in a Human Model of Systemic Inflammation: A Randomized Clinical Trial. Arterioscler Thromb Vasc Biol 2021; 41:e417-e426. [PMID: 34107730 DOI: 10.1161/atvbaha.121.316388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute and Hospital (M.O., Y.L., F.D.), University College London, United Kingdom
| | - Stefano Masi
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom.,Internal Medicine Unit, University of Pisa, Italy (S.M.)
| | - Devina Bhowruth
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom
| | - Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and Hospital (M.O., Y.L., F.D.), University College London, United Kingdom.,Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela and Medical-Surgical Dentistry Research Group (Y.L.), Health Research Institute of Santiago de Compostela, Spain.,Clinical Neurosciences Research Laboratory (Y.L.), Health Research Institute of Santiago de Compostela, Spain
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, United Kingdom (G.G.)
| | - Derek Yellon
- The Hatter Cardiovascular Institute (D.Y., D.J.H.), University College London, United Kingdom
| | - Aroon Hingorani
- Institute of Cardiovascular Science (A.H.), University College London, United Kingdom
| | - Scott T Chiesa
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute (D.Y., D.J.H.), University College London, United Kingdom.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.).,National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.).,Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.).,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.)
| | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital (M.O., Y.L., F.D.), University College London, United Kingdom
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Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Ağbaş A, Aitkenhead H, Anarat A, Aoun B, Aofolaju D, Bakkaloglu SA, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Deanfield J, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Stronach L, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schmitt CP, Schaefer F. Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study. J Am Soc Nephrol 2019; 30:678-691. [PMID: 30846560 DOI: 10.1681/asn.2018100990] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/26/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypertension and cardiovascular disease are common in children undergoing dialysis. Studies suggest that hemodiafiltration (HDF) may reduce cardiovascular mortality in adults, but data for children are scarce. METHODS The HDF, Heart and Height study is a nonrandomized observational study comparing outcomes on conventional hemodialysis (HD) versus postdilution online HDF in children. Primary outcome measures were annualized changes in carotid intima-media thickness (cIMT) SD score and height SD score. RESULTS We enrolled 190 children from 28 centers; 78 on HD and 55 on HDF completed 1-year follow-up. The groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow, and residual renal function. At 1 year, cIMT SD score increased significantly in children on HD but remained static in the HDF cohort. On propensity score analysis, HD was associated with a +0.47 higher annualized cIMT SD score compared with HDF. Height SD score increased in HDF but remained static in HD. Mean arterial pressure SD score increased with HD only. Factors associated with higher cIMT and mean arterial pressure SD-scores were HD group, higher ultrafiltration rate, and higher β2-microglobulin. The HDF cohort had lower β2-microglobulin, parathyroid hormone, and high-sensitivity C-reactive protein at 1 year; fewer headaches, dizziness, or cramps; and shorter postdialysis recovery time. CONCLUSIONS HDF is associated with a lack of progression in vascular measures versus progression with HD, as well as an increase in height not seen in the HD cohort. Patient-related outcomes improved among children on HDF correlating with improved BP control and clearances. Confirmation through randomized trials is required.
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Affiliation(s)
- Rukshana Shroff
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and .,Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom
| | - Colette Smith
- Statistics Department, Institute for Global Health, University College London, London, United Kingdom
| | - Bruno Ranchin
- Renal Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | | | - Varvara Askiti
- Nephrology Unit, Kyriakou Children's Hospital, Athens, Greece
| | - Karolis Azukaitis
- Nephrology Unit, Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania
| | - Nur Canpolat
- Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ayşe Ağbaş
- Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Helen Aitkenhead
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Ali Anarat
- Nephrology Unit, Cukurova University, Adana, Turkey
| | - Bilal Aoun
- Nephrology Unit, Armand Trousseau Hospital, Paris, France
| | - Daley Aofolaju
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | | | - Devina Bhowruth
- Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom
| | | | | | - Rainer Büscher
- Nephrology Unit, University Children Hospital Essen, Essen, Germany
| | - John Deanfield
- Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom
| | - Claire Dempster
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Ali Duzova
- Nephrology Unit, Hacettepe University, Ankara, Turkey
| | - Sandra Habbig
- Nephrology Unit, University Hospital Cologne, Cologne, Germany
| | - Wesley Hayes
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Shivram Hegde
- Nephrology Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Saoussen Krid
- Nephrology Unit, Hôpital Necker-Enfants Malades, Paris, France
| | - Christoph Licht
- Nephrology Unit, The Hospital for Sick Children, Toronto, Canada
| | - Mieczyslaw Litwin
- Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Mark Mayes
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Sevgi Mir
- Nephrology Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Rose Nemec
- Nephrology Unit, The Hospital for Sick Children, Toronto, Canada
| | - Lukasz Obrycki
- Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Fabio Paglialonga
- Nephrology Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Picca
- Nephrology Unit, Bambino Gesù" Children Research Hospital, Rome, Italy
| | | | - Mohan Shenoy
- Nephrology Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Manish D Sinha
- Nephrology Unit, Kings College London, Evelina London Children's Hospital, London, United Kingdom
| | | | - Lynsey Stronach
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Enrico Vidal
- Nephrology Unit, Pediatric Dialysis and Transplant Unit, Padova, Italy
| | - Karel Vondrák
- Nephrology Unit, University Hospital Motol, Prague, Czech Republic
| | - Alev Yilmaz
- Nephrology Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ariane Zaloszyc
- Nephrology Unit, Children's Dialysis Center, Strasbourg, France; and
| | - Michel Fischbach
- Nephrology Unit, Children's Dialysis Center, Strasbourg, France; and
| | - Claus Peter Schmitt
- Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Franz Schaefer
- Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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D'Aiuto F, Gkranias N, Bhowruth D, Khan T, Orlandi M, Suvan J, Masi S, Tsakos G, Hurel S, Hingorani AD, Donos N, Deanfield JE. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol 2018; 6:954-965. [PMID: 30472992 DOI: 10.1016/s2213-8587(18)30038-x] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes. METHODS In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA1c at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304. FINDINGS Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA1c was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA1c was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA1c, age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA1c was 0·6% (95% CI 0·3-0·9; p<0·0001) lower in the IPT group than in the CPT group. At least one adverse event was reported in 30 (23%) of 133 patients in the IPT group and 23 (18%) of 131 patients in the CPT group. Serious adverse events were reported in 11 (8%) patients in the IPT group, including one (1%) death, and 11 (8%) patients in the CPT group, including three (2%) deaths. INTERPRETATION Compared with CPT, IPT reduced HbA1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes. FUNDING Diabetes UK and UK National Institute for Health Research.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.
| | - Nikolaos Gkranias
- Centre for Clinical Oral Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Devina Bhowruth
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Tauseef Khan
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Jean Suvan
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Stefano Masi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Hurel
- Department of Endocrinology, University College London Hospitals, University College London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Nikos Donos
- Centre for Clinical Oral Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John E Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
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Masi S, Orlandi M, Parkar M, Bhowruth D, Kingston I, O'Rourke C, Virdis A, Hingorani A, Hurel SJ, Donos N, D'Aiuto F, Deanfield J. Mitochondrial oxidative stress, endothelial function and metabolic control in patients with type II diabetes and periodontitis: A randomised controlled clinical trial. Int J Cardiol 2018; 271:263-268. [PMID: 30077530 PMCID: PMC6152589 DOI: 10.1016/j.ijcard.2018.05.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Periodontitis (PD) and type 2 diabetes (T2D) are characterized by increased mitochondrial oxidative stress production (mtROS), which has been associated with a greater risk of cardiovascular diseases (CVD). Intensive PD treatment (IPT) can significantly improve endothelial function and metabolic control, although the mechanisms remain unclear. We explored whether, in patients with PD and T2D, changes of mtROS are associated with improvement of endothelial function and metabolic control after IPT. METHODS 51 patients with T2D and PD were enrolled in a single-blind controlled trial and randomised to either intensive (n = 27) or standard (CPT, n = 24) PD treatment. Levels of mtROS in peripheral blood mononuclear cells (PBMC) were measured using a FACS-based assay at baseline and 24 h, 1 week, 2 and 6 months after PD treatment. Inflammatory cytokines, CVD risk factors, metabolic control and endothelial function were assessed at baseline and 6 months after intervention. RESULTS After 6 months from PD treatment, the IPT group had lower mtROS (in both the whole PBMC and lymphocytes), circulating levels of HbA1c, glucose, INF-γ, TNF-α (p < 0.05 for all), and improved endothelial function (p < 0.05) compared to the CPT group. There was an association between higher mtROS and lower endothelial function at baseline (r = -0.39; p = 0.01) and, in the IPT group, changes of mtROS were associated with changes of endothelial function (r = 0.41; p < 0.05). CONCLUSIONS Reduced mtROS is associated with improved endothelial function and accompanied by better metabolic control in patients with T2D and PD. mtROS could represent a novel therapeutic target to prevent CVD in T2D.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy; National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK.
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK
| | - Mohamed Parkar
- Cruciform Teaching Facilities Unit, Faculty of Life Sciences, UCL, London, UK
| | - Devina Bhowruth
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK
| | - Isabel Kingston
- Biomaterials and Tissue Engineering, University College London, UK
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, UK
| | - Steven J Hurel
- Department of Endocrinology, University College London Hospital, London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London (QMUL), UK
| | | | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK
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Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Agbas A, Anarat A, Aoun B, Bakkaloglu S, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Ranchin B, Samaille C, Shenoy M, Sinha M, Smith C, Spasojevic B, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schaefer F, Schmitt CP. Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children - the HDF, heart and height (3H) study. BMC Nephrol 2018; 19:199. [PMID: 30097064 PMCID: PMC6086045 DOI: 10.1186/s12882-018-0998-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular disease is prevalent in children on dialysis and accounts for almost 30% of all deaths. Randomised trials in adults suggest that haemodiafiltration (HDF) with high convection volumes is associated with reduced cardiovascular mortality compared to high-flux haemodialysis (HD); however paediatric data are scarce. We designed the haemodiafiltration, heart and height (3H) study to test the hypothesis that children on HDF have an improved cardiovascular risk profile, growth and nutritional status and quality of life, compared to those on conventional HD. We performed a non-randomised parallel-arm intervention study within the International Paediatric Haemodialysis Network Registry comparing children on HDF and conventional HD to determine annualised change in cardiovascular end-points and growth. Here we present the 3H study design and baseline characteristics of the study population. METHODS 190 children were screened and 177 (106 on HD and 71 on HDF) recruited from 28 centres in 10 countries. There was no difference in age, underlying diagnosis, comorbidities, previous dialysis therapy, dialysis vintage, residual renal function, type of vascular access or blood flow between HD and HDF groups. High flux dialysers were used in 63% of HD patients and ultra-pure water was available in 52%. HDF patients achieved a median convection volume of 13.3 L/m2; this was associated with the blood flow rate only ((p = 0.0004, r = 0.42) and independent of access type (p = 0.38). DISCUSSION This is the largest study on dialysis outcomes in children that involves deep phenotyping across a wide range of cardiovascular, anthropometric, nutritional and health-related quality of life measures, to test the hypothesis that HDF leads to improved cardiovascular and growth outcomes compared to conventional HD. TRIAL REGISTRATION ClinicalTrials.gov: NCT02063776 . The trial was prospectively registered on the 14 Feb 2014.
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Affiliation(s)
- Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | | | | | | | | | | | - Ayse Agbas
- Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Bilal Aoun
- Armand Trousseau Hospital, Paris, France
| | | | - Devina Bhowruth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | | | - Claire Dempster
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Wesley Hayes
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | | | | | - Mark Mayes
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Sevgi Mir
- Ege University Faculty of Medicine, Izmir, Turkey
| | - Rose Nemec
- Hospital for Sick Children, Toronto, Canada
| | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Picca
- Bambino Gesù' Children Research Hospital, IRCCS, Rome, Italy
| | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | | | | | | | - Enrico Vidal
- Pediatric Dialysis and Transplant Unit, Padova, Italy
| | | | - Alev Yilmaz
- Istanbul University Faculty of Medical, Istanbul, Turkey
| | | | | | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Dangardt F, Charakida M, Chiesa S, Bhowruth D, Rapala A, Thurn D, Schaefer F, Deanfield J, Shroff R. Intimal and medial arterial changes defined by ultra-high-frequency ultrasound: Response to changing risk factors in children with chronic kidney disease. PLoS One 2018; 13:e0198547. [PMID: 29902198 PMCID: PMC6002120 DOI: 10.1371/journal.pone.0198547] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are exposed to both traditional 'Framingham' and uremia related cardiovascular risk factors that drive atherosclerotic and arteriosclerotic disease, but these cannot be differentiated using conventional ultrasound. We used ultra-high-frequency ultrasound (UHFUS) to differentiate medial thickness (MT) from intimal thickness (IT) in CKD patients, identify their determinants and monitor their progression. METHODS Fifty-four children and adolescents with CKD and 12 healthy controls underwent UHFUS measurements using 55-70MHz transducers in common carotid and dorsal pedal arteries. Annual follow-up imaging was performed in 31 patients. RESULTS CKD patients had higher carotid MT and dorsal pedal IT and MT compared to controls. The carotid MT in CKD correlated with serum phosphate (p<0.001, r = 0.42), PTH (p = 0.03, r = 0.36) and mean arterial pressure (p = 0.03, r = 0.34). Following multivariable analysis, being on dialysis, serum phosphate levels and mean arterial pressure remained the only independent predictors of carotid MT (R2 64%). Transplanted children had lower carotid and dorsal pedal MT compared to CKD and dialysis patients (p = 0.02 and p = 0.01 respectively). At 1-year follow-up, transplanted children had a decrease in carotid MT (p = 0.01), but an increase in dorsal pedal IT (p = 0.04) that independently correlated with annualized change in BMI. CONCLUSIONS Using UHFUS, we have shown that CKD is associated with exclusively medial arterial changes that attenuate when the uremic milieu is ameliorated after transplantation. In contrast, after transplantation intimal disease develops as hypertension and obesity become prevalent, representing rapid vascular remodeling in response to a changing cardiovascular risk factor profile.
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Affiliation(s)
- Frida Dangardt
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
- Department of Pediatric Clinical Physiology, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy and University Hospital, Gothenburg, Sweden
| | - Marietta Charakida
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Scott Chiesa
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Devina Bhowruth
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alicja Rapala
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Daniela Thurn
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - John Deanfield
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Rukshana Shroff
- Vascular Physiology Unit, National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, United Kingdom
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Eng CSY, Bhowruth D, Mayes M, Stronach L, Blaauw M, Barber A, Rees L, Shroff RC. Assessing the hydration status of children with chronic kidney disease and on dialysis: a comparison of techniques. Nephrol Dial Transplant 2018; 33:847-855. [DOI: 10.1093/ndt/gfx287] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Caroline S Y Eng
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Paediatric Nephrology Unit, Tuanku Ja’afar Hospital, Seremban, Malaysia
| | - Devina Bhowruth
- Vascular Physiology Unit, University College London Institute of Child Health, London, UK
| | - Mark Mayes
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lynsey Stronach
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle Blaauw
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Amy Barber
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lesley Rees
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rukshana C Shroff
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Vascular Physiology Unit, University College London Institute of Child Health, London, UK
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Dangardt F, Bhowruth D, Charakida M, Rapala A, Thurn D, Schaefer F, Deanfield J, Shroff R. SO058INTIMAL AND MEDIAL ARTERIAL CHANGES IN CHRONIC KIDNEY DISEASE: TIME TO RECONSIDER CONVENTIONAL IMT? Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw127.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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