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Savis A, Haseler E, Beardsley H, Chowienczyk PJ, Simpson JM, Sinha MD. Aortic Dilatation in Children and Young People With ADPKD. Kidney Int Rep 2024; 9:1210-1219. [PMID: 38707792 PMCID: PMC11068958 DOI: 10.1016/j.ekir.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/02/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Aortic root dilatation is a reported cardiovascular sequela seen in children and young people (CYP) with chronic kidney disease (CKD) but has yet to be described in those with autosomal dominant polycystic kidney disease (ADPKD). Methods Single center, cross-sectional study in a dedicated ADPKD clinic. Echocardiograms were evaluated for the presence of dilatation (defined by a z-score ≥2 [≥99th percentile] SDs from the mean) at 4 standardized locations, namely the aortic valve annulus, sinuses of Valsalva (SoV), sinotubular junction (STJ), and the ascending aorta. Measurements were compared with a control group to assess prevalence, severity, and determinants of aortic dilatation. Results Ninety-seven children, median age (interquartile range) of 9.3 (6.1, 13.6) years were compared with 19 controls without ADPKD or other CKD. The prevalence of dilatation ranged from 5.2% to 17% in ADPKD, depending on anatomical location with no aortic dilatation identified in the control group. In multivariable regression, aortic root dilatation was significantly associated with cyst burden at the aortic valve annulus and SoV (β = 0.42 and β = 0.39, both P < 0.001), with age at SoV (β = -0.26, P = 0.02), systolic blood pressure (SBP) z-score at SoV (β = -0.20, P = 0.04) and left ventricular mass index (LVMI) at SoV and STJ (β = 0.24, P = 0.02 and β = 0.25, P = 0.03, respectively) following adjustment for age, sex (male or female), body mass index (BMI) z-score, estimated glomerular filtration rate (eGFR), SBP z-score, and LVMI. Conclusion Our data suggests increased prevalence of aortic root and ascending aortic dilatation in CYP with ADPKD compared with controls. Further studies are needed to understand the pathogenesis and its contribution to the high cardiovascular morbidity in ADPKD.
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Affiliation(s)
- Alexandra Savis
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Hayley Beardsley
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | | | - John M. Simpson
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
- Department of Clinical Pharmacology, Kings College London, UK
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Newton J, Haseler E, Higgins C, Futcher C, Singh C, Sinha MD. Author response to Reliability of systolic blood pressure measured by parents in young children at home using a hand held doppler device and aneroid sphygmomanometer: methodological issue to avoid misinterpretation. J Hypertens 2024; 42:936-937. [PMID: 38573222 DOI: 10.1097/hjh.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Joanna Newton
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust
| | - Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust
| | - Colin Higgins
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust
| | - Charlotte Futcher
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust
| | | | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust
- Kings College, London, UK
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Gu H, Azukaitis K, Doyon A, Erdem S, Ranchin B, Harambat J, Lugani F, Boguslavskyi A, Cansick J, Finlay E, Gilbert R, Kerecuk L, Lunn A, Maxwell H, Morgan H, Shenoy M, Shroff R, Subramaniam P, Tizard J, Tse Y, Simpson J, Chowienczyk P, Schaefer F, Sinha MD. Decline in Left Ventricular Early Systolic Function with Worsening Kidney Function in Children with Chronic Kidney Disease: Insights from the 4C and HOT-KID Studies. J Am Soc Echocardiogr 2024; 37:356-363.e1. [PMID: 37993063 DOI: 10.1016/j.echo.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/27/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Adults with childhood-onset chronic kidney disease (CKD) have an increased risk of cardiovascular disease. First-phase ejection fraction (EF1), a novel measure of early systolic function, may be a more sensitive marker of left ventricular dysfunction than other markers in children with CKD. OBJECTIVE To examine whether EF1 is reduced in children with CKD. METHODS Children from the 4C and HOT-KID studies were stratified according to estimated glomerular filtration rate (eGFR). The EF1 was calculated from the fraction of left ventricular (LV) volume ejected up to the time of peak aortic flow velocity. RESULTS The EF1 was measured in children ages 10.9 ± 3.7 (mean ± SD) years, 312 with CKD and 63 healthy controls. The EF1 was lower, while overall ejection fraction was similar, in those with CKD compared with controls and decreased across stages of CKD (29.3% ± 3.7%, 23.5% ± 4.5%, 19.8% ± 4.0%, 18.5% ± 5.1%, and 16.7% ± 6.6% in controls, CKD 1, 2, 3, and ≥ 4, respectively, P < .001). The relationship of EF1 to eGFR persisted after adjustment for relevant confounders (P < .001). The effect size for association of measures of LV structure or function with eGFR (SD change per unit change in eGFR) was greater for EF1 (β = 0.365, P < .001) than for other measures: LV mass index (β = -0.311), relative wall thickness (β = -0.223), E/e' (β = -0.147), and e' (β = 0.141) after adjustment for confounders in children with CKD. CONCLUSIONS Children with CKD exhibit a marked and progressive decline in EF1 with falling eGFR. This suggests that EF1 is a more sensitive marker of LV dysfunction when compared to other structural or functional measures and that early LV systolic function is a key feature in the pathophysiology of cardiac dysfunction in CKD.
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Affiliation(s)
- Haotian Gu
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Anke Doyon
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Jerome Harambat
- Pediatric Nephrology Unit, Department of Pediatrics, Centre de Référence Maladies Rénales Rares, Bordeaux University Hospital, Bordeaux, France
| | - Francesca Lugani
- Division of Nephrology, Dialysis, Transplantation, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrii Boguslavskyi
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Janette Cansick
- Department of Paediatrics, Medway Maritime Hospital, Medway, United Kingdom
| | - Eric Finlay
- Department of Paediatric Nephrology, Leeds General Infirmary, Leeds, United Kingdom
| | - Rodney Gilbert
- Department of Paediatric Nephrology, Southampton General Hospital, Southampton, United Kingdom
| | - Larissa Kerecuk
- Department of Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Heather Maxwell
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, United Kingdom
| | - Pushpa Subramaniam
- Department of Paediatrics, St Georges Hospital, Tooting, London, United Kingdom
| | - Jane Tizard
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, United Kingdom
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, United Kingdom; Department of Paediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom.
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Newton J, Haseler E, Higgins C, Futcher C, Singh C, Sinha MD. Reliability of systolic blood pressure measured by parents in young children at home using a hand held doppler device and aneroid sphygmomanometer. J Hypertens 2024; 42:308-314. [PMID: 37889595 DOI: 10.1097/hjh.0000000000003602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE We report data regarding systolic BP monitoring in children aged <5 years performed over a 2-week period by parents at home using a hand-held doppler device and aneroid sphygmomanometer for SBP measurements (HDBPM). Our objectives were to compare health professional measured office systolic BP by doppler device (Office-SBP Doppler ) with parent measured home systolic BP using the same doppler device (Home-SBP Doppler ). We also report data evaluating reliability and optimal number of days of measurement required. DESIGN AND METHODS We taught parents to measure systolic BP and assessed their technique using a hand-held doppler device and aneroid sphygmomanometer. We requested parents to perform three consecutive BP measurements twice daily (ideally morning and evening around similar times) when the child was awake, settled and cooperative. RESULTS Over a 3-year period, data from 48 of 62 children who underwent HDBPM measurements were evaluated with median (IQR) age of 1.9 (0.9, 3.6) years, 27 (56%) boys and 14 (29%) on antihypertensive medication. Office-SBP Doppler was 2.9 ± 8.9 mmHg [95% confidence interval (CI), -14.4 to 20.4, P = 0.026] higher than Home-SBP Doppler . Mean Home-SBP Doppler between Week-1 and Week-2 monitoring was similar -0.45 ± 3.5 mmHg (95% CI, -7.35 to 6.45, P = 0.41). Morning HDBPM measurements were lower than evening with a mean difference of -2.77 ± 3.92 mmHg, P < 0.001). Over Week-1, mean Home-SBP Doppler was closer to mean Office-SBP Doppler with increasing cumulative days of monitoring and with smaller standard deviations suggesting that readings become more reliable from day 4 onwards. CONCLUSIONS HDBPM is a reliable method for measuring systolic BP in young children with BP levels measured by parents comparable to those performed by health professional in clinic. HDBPM technique described here and performed by parents over a 7-day period with a minimum of 4-days, offers a reliable and reproducible technique to measure blood pressure at home.
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Affiliation(s)
- Joanna Newton
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust
| | - Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust
| | - Colin Higgins
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust
| | - Charlotte Futcher
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust
| | | | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust
- Kings College London, London, UK
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Flohr C, Rosala-Hallas A, Jones AP, Beattie P, Baron S, Browne F, Brown SJ, Gach JE, Greenblatt D, Hearn R, Hilger E, Esdaile B, Cork MJ, Howard E, Lovgren ML, August S, Ashoor F, Williamson PR, McPherson T, O'Kane D, Ravenscroft J, Shaw L, Sinha MD, Spowart C, Taams LS, Thomas BR, Wan M, Sach TH, Irvine AD. Efficacy and safety of ciclosporin versus methotrexate in the treatment of severe atopic dermatitis in children and young people (TREAT): a multicentre parallel group assessor-blinded clinical trial. Br J Dermatol 2023; 189:674-684. [PMID: 37722926 DOI: 10.1093/bjd/ljad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/01/2023] [Accepted: 09/17/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Conventional systemic drugs are used to treat children and young people (CYP) with severe atopic dermatitis (AD) worldwide, but no robust randomized controlled trial (RCT) evidence exists regarding their efficacy and safety in this population. While novel therapies have expanded therapeutic options, their high cost means traditional agents remain important, especially in lower-resource settings. OBJECTIVES To compare the safety and efficacy of ciclosporin (CyA) with methotrexate (MTX) in CYP with severe AD in the TREatment of severe Atopic Eczema Trial (TREAT) trial. METHODS We conducted a parallel group assessor-blinded RCT in 13 UK and Irish centres. Eligible participants aged 2-16 years and unresponsive to potent topical treatment were randomized to either oral CyA (4 mg kg-1 daily) or MTX (0.4 mg kg-1 weekly) for 36 weeks and followed-up for 24 weeks. Co-primary outcomes were change from baseline to 12 weeks in Objective Severity Scoring of Atopic Dermatitis (o-SCORAD) and time to first significant flare (relapse) after treatment cessation. Secondary outcomes included change in quality of life (QoL) from baseline to 60 weeks; number of participant-reported flares following treatment cessation; proportion of participants achieving ≥ 50% improvement in Eczema Area and Severity Index (EASI 50) and ≥ 75% improvement in EASI (EASI 75); and stratification of outcomes by filaggrin status. RESULTS In total, 103 participants were randomized (May 2016-February 2019): 52 to CyA and 51 to MTX. CyA showed greater improvement in disease severity by 12 weeks [mean difference in o-SCORAD -5.69, 97.5% confidence interval (CI) -10.81 to -0.57 (P = 0.01)]. More participants achieved ≥ 50% improvement in o-SCORAD (o-SCORAD 50) at 12 weeks in the CyA arm vs. the MTX arm [odds ratio (OR) 2.60, 95% CI 1.23-5.49; P = 0.01]. By 60 weeks MTX was superior (OR 0.33, 95% CI 0.13-0.85; P = 0.02), a trend also seen for ≥ 75% improvement in o-SCORAD (o-SCORAD 75), EASI 50 and EASI 75. Participant-reported flares post-treatment were higher in the CyA arm (OR 3.22, 95% CI 0.42-6.01; P = 0.02). QoL improved with both treatments and was sustained after treatment cessation. Filaggrin status did not affect outcomes. The frequency of adverse events (AEs) was comparable between both treatments. Five (10%) participants on CyA and seven (14%) on MTX experienced a serious AE. CONCLUSIONS Both CyA and MTX proved effective in CYP with severe AD over 36 weeks. Participants who received CyA showed a more rapid response to treatment, while MTX induced more sustained disease control after discontinuation.
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Affiliation(s)
- Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anna Rosala-Hallas
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | - Susannah Baron
- Department of Paediatric Dermatology, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fiona Browne
- Paediatric Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sara J Brown
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Joanna E Gach
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Danielle Greenblatt
- Department of Paediatric Dermatology, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ross Hearn
- Ninewells Hospital and Medical School, Dundee, UK
| | - Eva Hilger
- Department of Paediatric Dermatology, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ben Esdaile
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Michael J Cork
- Sheffield Children's NHS Foundation Trust and Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Emma Howard
- Department of Paediatric Dermatology, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marie-Louise Lovgren
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Farhiya Ashoor
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Tess McPherson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Donal O'Kane
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Lindsay Shaw
- Bristol Royal Hospital for Children, Bristol, UK
| | - Manish D Sinha
- Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas's Foundation Hospitals NHS Trust, London
| | - Catherine Spowart
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, King's College London, UK
| | - Bjorn R Thomas
- Royal Free Hospital and Blizard Institute, Queen Mary University London, UK
| | - Mandy Wan
- Evelina London Children's Hospital, Guys' and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alan D Irvine
- Paediatric Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland
- Clinical Medicine, Trinity College Dublin, Ireland
- National Children's Research Centre, Crumlin, Dublin, Ireland
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Chung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R. Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:2280-2292. [PMID: 37737026 DOI: 10.1161/hypertensionaha.123.20967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.
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Affiliation(s)
- Jason Chung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (J.C.)
| | - Cal Robinson
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada (C.R.)
| | - Lauren Sheffield
- Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada (L.S.)
| | - Prathayini Paramanathan
- All Saints University College of Medicine, Kingstown, Saint Vincent and the Grenadines (P.P.)
| | - Andrew Yu
- Faculty of Science, University of Alberta, Edmonton, Canada (A.Y.)
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada (S.S.)
| | - Mark Mitsnefes
- Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Department of Pediatrics and Medicine, Division of Nephrology, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada (R.S.P.)
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, United Kingdom (M.D.S.)
| | - Myanca Rodrigues
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (M.R.)
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
- University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, Canada (J.D.)
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
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7
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Plumb L, Casula A, Sinha MD, Inward CD, Marks SD, Medcalf J, Nitsch D. Epidemiology of childhood acute kidney injury in England using e-alerts. Clin Kidney J 2023; 16:1288-1297. [PMID: 37529656 PMCID: PMC10387403 DOI: 10.1093/ckj/sfad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 08/03/2023] Open
Abstract
Background Few studies describe the epidemiology of childhood acute kidney injury (AKI) nationally. Laboratories in England are required to issue electronic (e-)alerts for AKI based on serum creatinine changes. This study describes a national cohort of children who received an AKI alert and their clinical course. Methods A cross-section of AKI episodes from 2017 are described. Hospital record linkage enabled description of AKI-associated hospitalizations including length of stay (LOS) and critical care requirement. Risk associations with critical care (hospitalized cohort) and 30-day mortality (total cohort) were examined using multivariable logistic regression. Results In 2017, 7788 children (52% male, median age 4.4 years, interquartile range 0.9-11.5 years) experienced 8927 AKI episodes; 8% occurred during birth admissions. Of 5582 children with hospitalized AKI, 25% required critical care. In children experiencing an AKI episode unrelated to their birth admission, Asian ethnicity, young (<1 year) or old (16-<18 years) age (reference 1-<5 years), and high peak AKI stage had higher odds of critical care. LOS was higher with peak AKI stage, irrespective of critical care admission. Overall, 30-day mortality rate was 3% (n = 251); youngest and oldest age groups, hospital-acquired AKI, higher peak stage and critical care requirement had higher odds of death. For children experiencing AKI alerts during their birth admission, no association was seen between higher peak AKI stage and critical care admission. Conclusions Risk associations for adverse AKI outcomes differed among children according to AKI type and whether hospitalization was related to birth. Understanding the factors driving AKI development and progression may help inform interventions to minimize morbidity.
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Affiliation(s)
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Manish D Sinha
- Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK
- British Heart Foundation Centre, Kings College London, London, UK
| | - Carol D Inward
- Department of Paediatric Nephrology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - James Medcalf
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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8
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Lurbe E, Mancia G, Drozdz D, Erdine S, Fernandez-Aranda F, Litwin M, Sinha MD, Simonetti G, Stabouli S, Wühl E. HyperChildNET: A European Network Moving Forward in the Field of Pediatric Hypertension. Hypertension 2023; 80:e71-e73. [PMID: 36748460 DOI: 10.1161/hypertensionaha.123.20080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain (E.L., F.F.-A.)
| | - Giuseppe Mancia
- Department of Pediatrics, Consorcio Hospital General, University of Valencia, Spain (E.L.). University of Milano-Bicocca, Italy (G.M.)
| | - Dorota Drozdz
- Department of Pediatric Nephrology and Hypertension, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland (D.D.)
| | - Serap Erdine
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Turkey (S.E.)
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain (E.L., F.F.-A.)
- University Hospital of Bellvitge, IDIBELL (F.F.-A.), University of Barcelona, Spain
- Department of Clinical Sciences (F.F.-A.), University of Barcelona, Spain
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.)
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.D.S.)
| | - Giacomo Simonetti
- Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona (G.S.)
| | - Stella Stabouli
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital of Thessaloniki, Greece (S.S.)
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Germany (E.W.)
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9
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Savis A, Simpson JM, Kabir S, Peacock K, Beardsley H, Sinha MD. Prevalence of cardiac valvar abnormalities in children and young people with autosomal dominant polycystic kidney disease. Pediatr Nephrol 2023; 38:705-709. [PMID: 35763085 DOI: 10.1007/s00467-022-05500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Valvar abnormalities in children and adults with autosomal dominant polycystic kidney disease (ADPKD) have previously been reported as a frequent occurrence. Mitral valve prolapse (MVP), in particular, has been reported in almost one-third of adult patients and nearly 12% of children with ADPKD. Our objective in this study was to establish the prevalence of valvar abnormalities in a large, contemporary series of children and young people (CYP) with ADPKD. METHODS A retrospective, single centre, cross-sectional analysis of the echocardiograms performed on all consecutive children seen in a dedicated paediatric ADPKD clinic. Full anatomical and functional echocardiograms were performed and analysed for valvar abnormalities. RESULTS The echocardiograms of 102 CYP with ADPKD (range 0.25-18 years, mean age 10.3 years, SD ± 5.3 years) were analysed. One (0.98%), 3-year-old boy, had MVP. There was no associated mitral regurgitation. Evaluating variations in normal valvar anatomy, 9 (8.8%) patients, aged 7.1 to 18 years, had minor bowing ± visual elongation of either the anterior or posterior leaflet of the mitral valve, none of which fell within the criteria of true MVP. Three (1.9%) patients, 2 boys and 1 girl aged between 7 and 14 years, had trivial or mild aortic regurgitation. No patients had echocardiographic evidence of tricuspid valve prolapse (TVP). CONCLUSION In this contemporary cohort of CYP with ADPKD, the incidence of MVP and other valvar lesions is significantly lower than previously reported. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Alexandra Savis
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - John M Simpson
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Saleha Kabir
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Kelly Peacock
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Hayley Beardsley
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- Kings College London, London, UK.
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10
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Li Y, Haseler E, McNally R, Sinha MD, Chowienczyk PJ. A meta-analysis of the haemodynamics of primary hypertension in children and adults. J Hypertens 2023; 41:212-219. [PMID: 36583348 PMCID: PMC9799046 DOI: 10.1097/hjh.0000000000003326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 12/31/2022]
Abstract
We performed a systematic review and meta-analysis to determine the relative contributions of elevated cardiac output and systemic vascular resistance to hypertension in children and adults. This included 27 studies on 11 765 hypertensive and normotensive children and adults in whom cardiac output was measured. Cardiac output but not systemic vascular resistance was elevated in hypertensive compared to normotensive children and young adults (difference in means 1.15 [0.78-1.52] l/min, P < 0.001). In older hypertensive adults, both were elevated compared to normotensive individuals (0.40 [0.26-0.55] l/min, P < 0.001 and 3.21 [1.91-4.51] mmHg min/l, P < 0.001 for cardiac output and systemic vascular resistance, respectively). The main haemodynamic alteration in primary hypertension (including obesity-hypertension) in both children and young to middle-aged adults is an elevation of cardiac output. With longer duration and greater severity of hypertension there may be progression from a 'cardiac' to a 'vascular' phenotype with increased systemic vascular resistance.
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Affiliation(s)
- Ye Li
- King's College London British Heart Foundation Centre, St. Thomas’ Hospital, Westminster Bridge
| | | | - Ryan McNally
- King's College London British Heart Foundation Centre, St. Thomas’ Hospital, Westminster Bridge
| | - Manish D. Sinha
- King's College London British Heart Foundation Centre, St. Thomas’ Hospital, Westminster Bridge
- Evelina Children's Hospital, London, UK
| | - Phil J. Chowienczyk
- King's College London British Heart Foundation Centre, St. Thomas’ Hospital, Westminster Bridge
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11
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Picone DS, Stoneman E, Cremer A, Schultz MG, Otahal P, Hughes AD, Black JA, Bos WJ, Chen CH, Cheng HM, Dwyer N, Lacy P, Laugesen E, Liang F, Kim HL, Ohte N, Okada S, Omboni S, Ott C, Pereira T, Pucci G, Rajani R, Schmieder R, Sinha MD, Stewart R, Stouffer GA, Takazawa K, Wang J, Weber T, Westerhof BE, Williams B, Yamada H, Sharman JE. Sex Differences in Blood Pressure and Potential Implications for Cardiovascular Risk Management. Hypertension 2023; 80:316-324. [PMID: 35912678 DOI: 10.1161/hypertensionaha.122.19693] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/21/2023]
Abstract
BACKGROUND Accurate blood pressure (BP) measurement is critical for optimal cardiovascular risk management. Age-related trajectories for cuff-measured BP accelerate faster in women compared with men, but whether cuff BP represents the intraarterial (invasive) aortic BP is unknown. This study aimed to determine the sex differences between cuff BP, invasive aortic BP, and the difference between the 2 measurements. METHODS Upper-arm cuff BP and invasive aortic BP were measured during coronary angiography in 1615 subjects from the Invasive Blood Pressure Consortium Database. This analysis comprised 22 different cuff BP devices from 28 studies. RESULTS Subjects were 64±11 years (range 40-89) and 32% women. For the same cuff systolic BP (SBP), invasive aortic SBP was 4.4 mm Hg higher in women compared with men. Cuff and invasive aortic SBP were higher in women compared with men, but the sex difference was more pronounced from invasive aortic SBP, was the lowest in younger ages, and the highest in older ages. Cuff diastolic blood pressure overestimated invasive diastolic blood pressure in both sexes. For cuff and invasive diastolic blood pressure separately, there were sex*age interactions in which diastolic blood pressure was higher in younger men and lower in older men, compared with women. Cuff pulse pressure underestimated invasive aortic pulse pressure in excess of 10 mm Hg for both sexes in older age. CONCLUSIONS For the same cuff SBP, invasive aortic SBP was higher in women compared with men. How this translates to cardiovascular risk prediction needs to be determined, but women may be at higher BP-related risk than estimated by cuff measurements.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Elif Stoneman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Antoine Cremer
- Department of Cardiology/Hypertension, University Hospital of Bordeaux, France (A.C.)
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.)
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H.)
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.).,Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D.)
| | - Willem Jan Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.B.).,Department of Internal Medicine, Leiden University Medical Center, The Netherlands (W.J.B.)
| | - Chen-Huan Chen
- Department of Internal Medicine, National Yang Ming Chiao Tung University College of Medicine (C.-H.C.)
| | - Hao-Min Cheng
- Department of Medicine (H.-M.C.), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Public Health (H.-M.C.), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine (H.-M.C.), Taipei Veterans General Hospital, Taiwan.,Department of Medical Education (H.-M.C.), Taipei Veterans General Hospital, Taiwan.,Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan (H.-M.C.)
| | - Nathan Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.).,Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D.)
| | - Peter Lacy
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.L., B.W.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (E.L.)
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, China (F.L.).,World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, Russia (F.L.)
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Hospital, Seoul, South Korea (H.-L.K.)
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan (N.O.)
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan (S.O.)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S.O.).,Department of Cardiology, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.S.)
| | - Telmo Pereira
- Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal (T.P.).,Laboratory for Applied Health Research (LabinSaúde), Coimbra, Portugal (T.P.)
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Ronak Rajani
- Cardiology Department, Guy's and St. Thomas' Hospitals, London, United Kingdom (R.R.)
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.S.)
| | - Manish D Sinha
- Kings College London British Heart Foundation Centre and Department of Clinical Pharmacology and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (M.D.S)
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, New Zealand (R.S.)
| | - George A Stouffer
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill (G.A.S)
| | - Kenji Takazawa
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Japan (K.T.)
| | - Jiguang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.)
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands (B.E.W.)
| | - Bryan Williams
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.L., B.W.)
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima Graduate School of Biomedical Sciences, Japan (H.Y.)
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12
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Sinha MD, Gu H, Douiri A, Cansick J, Finlay E, Gilbert R, Kerecuk L, Lunn A, Maxwell H, Morgan H, Shenoy M, Shroff R, Subramaniam P, Tizard J, Tse Y, Rezavi R, Simpson JM, Chowienczyk PJ. Intensive compared with less intensive blood pressure control to prevent adverse cardiac remodelling in children with chronic kidney disease (HOT-KID): a parallel-group, open-label, multicentre, randomised, controlled trial. The Lancet Child & Adolescent Health 2023; 7:26-36. [PMID: 36442482 PMCID: PMC10202819 DOI: 10.1016/s2352-4642(22)00302-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optimal target blood pressure to reduce adverse cardiac remodelling in children with chronic kidney disease is uncertain. We hypothesised that lower blood pressure would reduce adverse cardiac remodelling. METHODS HOT-KID, a parallel-group, open-label, multicentre, randomised, controlled trial, was done in 14 clinical centres across England and Scotland. We included children aged 2-15 years with stage 1-4 chronic kidney disease-ie, an estimated glomerular filtration rate (eGFR) higher than 15 mL/min per 1·73 m2-and who could be followed up for 2 years. Children on antihypertensive medication were eligible as long as it could be changed to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) if they were not already receiving these therapies. Participants were randomly assigned (1:1) to standard treatment (auscultatory office systolic blood pressure target between the 50th and 75th percentiles) or intensive treatment (systolic target <40th percentile) by the chief investigator using a rapid, secure, web-based randomisation system. ACE inhibitors or ARBs were used as first-line agents, with the dose titrated every 2-4 weeks to achieve the target blood pressure levels. The primary outcome was mean annual difference in left ventricular mass index (LVMI) by echocardiography measured by a masked observer and was assessed in the intention-to-treat population, defined as all the children who underwent randomisation irrespective of the blood pressure reached. Secondary and safety outcomes were the differences between groups in mean left ventricular relative wall thickness, renal function, and adverse effects and were also assessed in the intention-to-treat population. This trial is registered with ISRCTN, ISRCTN25006406. FINDINGS Between Oct 30, 2012, and Jan 5, 2017, 64 participants were randomly assigned to the intensive treatment group and 60 to the standard treatment group (median age of participants was 10·0 years [IQR 6·8-12·6], 69 [56%] were male and 107 [86%] were of white ethnicity). Median follow-up was 38·7 months (IQR 28·1-52·2). Blood pressure was lower in the intensive treatment group compared with standard treatment group (mean systolic pressure lower by 4 mm Hg, p=0·0012) but in both groups was close to the 50th percentile. The mean annual reduction in LVMI was similar for intensive and standard treatments (-1·9 g/m2·7 [95% CI -2·4 to -1·3] vs -1·2 g/m2·7 [-1·5 to 0·8], with a treatment effect of -0·7 g/m2·7 [95% CI -1·9 to 2·6] per year; p=0·76) and mean value in both groups at the end of follow-up within the normal range. At baseline, elevated relative wall thickness was more marked than increased LVMI and a reduction in relative wall thickness was greater for the intensive treatment group than for the standard treatment group (-0·010 [95% CI 0·015 to -0·006] vs -0·004 [-0·008 to 0·001], treatment effect -0·020 [95% CI -0·039 to -0·009] per year, p=0·0019). Six (5%) participants reached end-stage kidney disease (ie, an eGFR of <15 mL/min per 1·73 m2; three in each group) during the course of the study. The risk difference between treatment groups was 0·02 (95% CI -0·15 to 0·19, p=0·82) for overall adverse events and 0·07 (-0·05 to 0·19, p=0·25) for serious adverse events. Intensive treatment was not associated with worse renal outcomes or greater adverse effects than standard treatment. INTERPRETATION These results suggest that cardiac remodelling in children with chronic kidney disease is related to blood pressure control and that a target office systolic blood pressure at the 50th percentile is close to the optimal target for preventing increased left ventricular mass. FUNDING British Heart Foundation.
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Affiliation(s)
- Manish D Sinha
- British Heart Foundation Centre, King's College London, London, UK; Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Haotian Gu
- British Heart Foundation Centre, King's College London, London, UK
| | - Abdel Douiri
- Department of Medical Statistics, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Janette Cansick
- Department of Paediatrics, Medway Maritime Hospital, Medway, UK
| | - Eric Finlay
- Department of Paediatric Nephrology, Leeds General Infirmary, Leeds, UK
| | - Rodney Gilbert
- Department of Paediatric Nephrology, Southampton General Hospital, Southampton, UK
| | - Larissa Kerecuk
- Department of Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, UK
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Heather Maxwell
- Department of Paediatric Nephrology, Glasgow Royal Infirmary, Glasgow, UK
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, UK
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | | | - Jane Tizard
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Reza Rezavi
- Division of Imaging Sciences, King's College London, London, UK
| | - John M Simpson
- British Heart Foundation Centre, King's College London, London, UK; Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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Balasubramanian R, Folwell R, Wheatley A, Ramsey H, Barton C, Reid CJD, Sinha MD. Developing a trigger tool to monitor adverse events during haemodialysis in children: a pilot project. Pediatr Nephrol 2023; 38:1233-1240. [PMID: 35913566 PMCID: PMC9925574 DOI: 10.1007/s00467-022-05673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We developed a paediatric haemodialysis trigger tool (pHTT) for application per haemodialysis (HD) session in children receiving intermittent in-centre HD and systematically monitored adverse events. METHODS Single-centre quality improvement study performed over two 8-week cycles. Data collected prospectively using a 'per-dialysis session' pHTT tool including 54 triggers across six domains, adapted from a recently described haemodialysis trigger tool (HTT) for adults. Each trigger was evaluated for level of harm following assessment by two authors. Following a period of training, HD nurses completed the HTT at the end of each dialysis session. RESULTS There were 241 triggers over 182 dialysis sessions, with 139 triggers in 91 HD sessions for 15 children, age range 28-205 months, over an 8-week period (first cycle) and 102 triggers in 91 HD sessions for 13 children, age range 28-205 months, over a further 8-week period (second cycle). After interventions informed by the pHTT, the harm rate per session was significantly reduced from 1.03 (94/91) to 0.32 (29/91), P < 0.001. There was a significant difference between the distribution of triggers by harm category (P < 0.001) and between the proportion of triggers across the various domains of the pHTT (P = 0.004) between the two cycles. No triggers were evaluated as causing permanent harm. CONCLUSIONS This pilot study demonstrates potential benefits of a bedside tool to monitor adverse events during haemodialysis in children. Thus, following interventions informed by the pHTT, the harm rate per session was significantly reduced. Under standard patient safety systems, the vast majority of triggers identified by the pHTT would remain unreported and perhaps lead to missed opportunities to improve patient safety. We propose the use of a paediatric HTT as part of standard care by centres providing HD to children in the future. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ramnath Balasubramanian
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK
| | - Rachel Folwell
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK
| | - Arran Wheatley
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK
| | - Heidi Ramsey
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK
| | - Carmen Barton
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK
| | - Christopher J. D. Reid
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH UK ,Kings College London, London, UK
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14
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Lurbe E, Mancia G, Calpe J, Drożdż D, Erdine S, Fernandez-Aranda F, Hadjipanayis A, Hoyer PF, Jankauskiene A, Jiménez-Murcia S, Litwin M, Mazur A, Pall D, Seeman T, Sinha MD, Simonetti G, Stabouli S, Wühl E. Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 1. How to correctly measure blood pressure in children and adolescents. Front Pediatr 2023; 11:1140357. [PMID: 37138561 PMCID: PMC10150446 DOI: 10.3389/fped.2023.1140357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.
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Affiliation(s)
- Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
- Correspondence: Empar Lurbe Elke Wühl Adamos Hadjipanayis
| | | | | | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Serap Erdine
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Adamos Hadjipanayis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
- Correspondence: Empar Lurbe Elke Wühl Adamos Hadjipanayis
| | - Peter F. Hoyer
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Artur Mazur
- Institute of Medical Sciences, Medical College, Rzeszów University, Rzeszow, Poland
| | - Denes Pall
- Department of Medical Clinical Pharmacology, University of Debrecen, Debrecen, Hungary
- Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tomas Seeman
- Division of Pediatric Nephrology, University Children’s Hospital, Charles University, Prague, Czechia
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Giacomo Simonetti
- Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Correspondence: Empar Lurbe Elke Wühl Adamos Hadjipanayis
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15
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Rus RR, Pac M, Obrycki Ł, Sağsak E, Azukaitis K, Sinha MD, Jankauskiene A, Litwin M. Systolic and diastolic left ventricular function in children with primary hypertension: a systematic review and meta-analysis. J Hypertens 2023; 41:51-62. [PMID: 36453653 DOI: 10.1097/hjh.0000000000003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Evaluation of left ventricular function provides early evidence of target-organ damage in children with primary hypertension. We performed a systematic review and meta-analysis of left ventricular systolic and diastolic function in children and adolescents with primary hypertension. METHODS Literature search was performed in PubMed database and out of 718 articles (published between 2000 and 2021) 22 studies providing comparison of left ventricular function parameters between children with primary hypertension and normotensive controls were selected. RESULTS Overall, 3460 children (5-21 years) with primary hypertension were analyzed. Meta-analysis showed that hypertensive patients when compared with normotensives, had an increased heart rate (mean difference [MD] 5.59; 95% confidence interval [CI] 3.28, 7.89; 10 studies) and increased fractional shortening (MD 1.04; 95% CI 0.48, 1.60; 9 studies) but did not differ in ejection fraction (MD -0.03; 95% CI -1.07, 1.02; 12 studies). Stroke volume was higher in one out of three studies, whereas no differences in cardiac output were found in two studies with available data. Hypertensive children had also lower E/A values (MD -0.21; -0.33, -0.09; 14 studies), greater values of E/e' (MD 0.59; 0.36, 0.82; 8 studies) and greater global longitudinal stress (MD 2.50; 2.03, 2.96; 4 studies) when compared to those with normotension. CONCLUSION Our results indicate that hypertensive children and adolescents present with signs of hyperkinetic function of the left ventricle, demonstrate evidence of increased left ventricular strain and impaired diastolic function compared to normotensive controls.
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Affiliation(s)
- Rina R Rus
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Michał Pac
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Łukasz Obrycki
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Elif Sağsak
- Yeditepe University, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Manish D Sinha
- King's College London, Department of Paediatric Nephrology, Evelina London Children's, Hospital, London, UK
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
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16
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Wühl E, Calpe J, Drożdż D, Erdine S, Fernandez-Aranda F, Hadjipanayis A, Hoyer PF, Jankauskiene A, Jiménez-Murcia S, Litwin M, Mancia G, Mazur A, Pall D, Seeman T, Sinha MD, Simonetti G, Stabouli S, Lurbe E. Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 2. How to manage high blood pressure in children and adolescents. Front Pediatr 2023; 11:1140617. [PMID: 37124176 PMCID: PMC10130632 DOI: 10.3389/fped.2023.1140617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. Arterial hypertension is not only the most important risk factor for cardiovascular morbidity and mortality, but also the most important modifiable risk factor. Early hypertension-mediated organ damage may already occur in childhood. The duration of existing hypertension plays an important role in risk assessment, and structural and functional organ changes may still be reversible or postponed with timely treatment. Therefore, appropriate therapy should be initiated in children as soon as the diagnosis of arterial hypertension has been confirmed and the risk factors for hypertension-mediated organ damage have been thoroughly evaluated. Lifestyle measures should be recommended in all hypertensive children and adolescents, including a healthy diet, regular exercise, and weight loss, if appropriate. If lifestyle changes in patients with primary hypertension do not result in normalization of blood pressure within six to twelve months or if secondary or symptomatic hypertension or hypertension-mediated organ damage is already present, pharmacologic therapy is required. Regular follow-up to assess blood pressure control and hypertension-mediated organ damage and to evaluate adherence and side effects of pharmacologic treatment is required. Timely multidisciplinary evaluation is recommended after the first suspicion of hypertension. A grading system of the clinical evidence is included.
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Affiliation(s)
- Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Correspondence: Elke Wühl Empar Lurbe Adamos Hadjipanayis
| | | | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Pediatric Institute, Jagiellonian University Medical College, Cracow, Poland
| | - Serap Erdine
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Fernando Fernandez-Aranda
- University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
- CIBER Fisiopatología de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Adamos Hadjipanayis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
- Correspondence: Elke Wühl Empar Lurbe Adamos Hadjipanayis
| | - Peter F. Hoyer
- Klinik für Kinderheilkunde II, Zentrum für Kinder und Jugendmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Susana Jiménez-Murcia
- University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
- CIBER Fisiopatología de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Artur Mazur
- Institute of Medical Sciences, Medical College, Rzeszów University, Rzeszow, Poland
| | - Denes Pall
- Department of Medical Clinical Pharmacology and Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tomas Seeman
- Division of Pediatric Nephrology, UniversityChildren's Hospital, Charles University, Prague, Czech Republic
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Manish D. Sinha
- Department of Pediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Giacomo Simonetti
- Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Empar Lurbe
- CIBER Fisiopatología de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
- Correspondence: Elke Wühl Empar Lurbe Adamos Hadjipanayis
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17
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Chandak P, Kessaris N, Karunanithy N, Byrne N, Newton J, Bharadwaj R, Assia-Zamora S, Shenoy M, Sallam M, Sinha MD. Utilizing 3D printing to facilitate surgical in-situ paediatric renal artery aneurysm repair for refractory hypertension. J Hypertens 2023; 41:194-197. [PMID: 36129111 DOI: 10.1097/hjh.0000000000003296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Renal artery aneurysmal (RAA) disease is a rare, but potentially life-threatening cause of renovascular disease presenting with hypertension. Conventional management involves aneurysmal excision followed by renal auto-transplantation. We present the management of a 13-year-old girl with complex multiple saccular aneurysmal disease of the left renal artery with hilar extension and symptomatic hypertension. We used 3D printing to print a patient-specific model that was not implanted in the patient but was used for surgical planning and discussion with the patient and their family. Endovascular options were precluded due to anatomical complexities. Following multi-disciplinary review and patient-specific 3D printing, she underwent successful in-situ RAA repair with intraoperative cooling, without the need for auto-transplantation. 3D printing enabled appreciation of aneurysmal spatial configuration and dimensions that also helped plan the interposition graft length needed following aneurysmal excision. The models provided informed multidisciplinary communications and proved valuable during the consent process with the family for this high-risk procedure. To our knowledge, this is the first reported case utilizing 3D printing to facilitate in-situ complex repair of RAA with intra-hilar extension for paediatric renovascular disease.
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Affiliation(s)
- Pankaj Chandak
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Nicos Kessaris
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Narayan Karunanithy
- Department of Interventional Radiology, Evelina London Children's Hospital, Guy's and St Thomas' Hospitals NHS Trust
| | - Nick Byrne
- Department of Imaging Science and Biomedical Engineering, King's College London
| | - Joanna Newton
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust
| | - R Bharadwaj
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Sergio Assia-Zamora
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Manchester University NHS Foundation Trust
| | - Morad Sallam
- Department of Vascular Surgery, Guy's and St Thomas' Hospitals NHS Trust
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust
- Kings College London, London, UK
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18
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Paglialonga F, Monzani A, Prodam F, Smith C, De Zan F, Canpolat N, Agbas A, Bayazit A, Anarat A, Bakkaloglu SA, Askiti V, Stefanidis CJ, Azukaitis K, Bulut IK, Borzych-Dużałka D, Duzova A, Habbig S, Krid S, Licht C, Litwin M, Obrycki L, Ranchin B, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Vidal E, Yilmaz A, Fischbach M, Schaefer F, Schmitt CP, Edefonti A, Shroff R. Nutritional and Anthropometric Indices in Children Receiving Haemodiafiltration vs Conventional Haemodialysis - The HDF, Heart and Height (3H) Study. J Ren Nutr 2023; 33:17-28. [PMID: 35870690 DOI: 10.1053/j.jrn.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/25/2022] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The "HDF-Heart-Height" study showed that haemodiafiltration (HDF) is associated with improved growth compared to conventional haemodialysis (HD). We report a post-hoc analysis of this study assessing the effect of extracorporeal dialysis therapies on nutritional indices. METHODS 107 children were included in the baseline cross-sectional analysis, of whom 79 (43 HD, 36 HDF) completed the 12-month follow-up. Height (Ht), optimal 'dry' weight (Wt), and body mass index (BMI) standard deviations scores (SDS), waist-to-hip ratio, des-acyl ghrelin (DAG), adiponectin, leptin, insulin-like growth factor-1 (IGF-1)-SDS and insulin were measured. RESULTS The levels of nutritional indices were comparable between HDF and HD patients at baseline and 12-month. On univariable analyses Wt-SDS positively correlated with leptin and IGF-1-SDS, and negatively with DAG, while Ht-SDS of the overall cohort positively correlated with IGF1-SDS and inversely with DAG and adiponectin. On multivariable analyses, higher 12-month Ht-SDS was inversely associated with baseline DAG (beta = -0.13 per 500 higher; 95%CI -0.22, -0.04; P = .004). Higher Wt-SDS at 12-month was positively associated with HDF modality (beta = 0.47 vs HD; 95%CI 0.12-0.83; P = .01) and inversely with baseline DAG (beta = -0.18 per 500 higher; 95%CI -0.32, -0.05; P = .006). Growth Hormone (GH) treated patients receiving HDF had higher annualized increase in Ht SDS compared to those on HD. CONCLUSIONS In children on HD and HDF both Wt- and Ht-SDS independently correlated with lower baseline levels of the anorexygenic hormone DAG. HDF may attenuate the resistance to GH, but further studies are required to examine the mechanisms linking HDF to improved growth.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alice Monzani
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Colette Smith
- Institute of Global Health, University College London, London, UK
| | - Francesca De Zan
- University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | | | - Ayse Agbas
- Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | | | | | | | | | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | | | | | | | | | | | | | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | | | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | - Manish D Sinha
- Kings College London Evelina London Children's Hospital, London, UK
| | | | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Italy
| | - Alev Yilmaz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | | | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
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19
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Musajee M, Gasparini M, Stewart DJ, Karunanithy N, Sinha MD, Sallam M. Middle aortic syndrome in children and adolescents. Glob Cardiol Sci Pract 2022; 2022:e202220. [PMID: 36660171 PMCID: PMC9840135 DOI: 10.21542/gcsp.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
Middle aortic syndrome is a rare form of renovascular disease that may present with severe hypertension during childhood. Narrowing of the abdominal aorta is often associated with narrowing of the renal and/or other visceral arteries and may be secondary to specific genetic syndromes. Following the optimization of blood pressure control, significant aortic narrowing often requires invasive management, including endovascular and surgical intervention. In younger children, endovascular therapy may be attempted in the first instance to acutely reduce the pressure gradient across the narrowing; however, a sustained benefit is rare. Once the child has grown to accommodate a graft of an adequate size, surgical therapy is indicated for patients in whom medical and/or endovascular management has not resulted in adequate blood pressure control. It is critical that individuals with middle aortic syndrome be managed by an experienced multidisciplinary team that includes medical, endovascular, and surgical expertise that can provide long-term care to monitor for recurrent hypertension and evidence of end-organ damage.
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Affiliation(s)
- Mustafa Musajee
- Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marisa Gasparini
- Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Douglas J. Stewart
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Narayan Karunanithy
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom,Kings College London, London, United Kingdom
| | - Morad Sallam
- Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom,Kings College London, London, United Kingdom
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20
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Abstract
Primary hypertension (PH) is most common during adolescence with increasing prevalence globally, alongside the epidemic of obesity. Unlike in adults, there are no data on children with uncontrolled hypertension and their future risk of hard cardiovascular and cerebrovascular outcomes. However, hypertension in childhood is linked to hypertensive-mediated organ damage (HMOD) which is often reversible if treated appropriately. Despite differing guidelines regarding the threshold for defining hypertension, there is consensus that early recognition and prompt management with lifestyle modification escalating to antihypertensive medication is required to ameliorate adverse outcomes. Unfortunately, many unknowns remain regarding pathophysiology and optimum treatment of childhood hypertension.
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Affiliation(s)
- Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, 3rd Floor Beckett House, London SE1 7EH, United Kingdom; Kings College London, United Kingdom
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, 3rd Floor Beckett House, London SE1 7EH, United Kingdom; Kings College London, United Kingdom.
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21
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Taylor PD, Gu H, Saunders H, Fiori F, Dalrymple KV, Sethupathi P, Yamanouchi L, Miller F, Jones B, Vieira MC, Singh C, Briley A, Seed PT, Pasupathy D, Santosh PJ, Groves AM, Sinha MD, Chowienczyk PJ, Poston L. Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT. Int J Obes (Lond) 2022; 46:2145-2155. [PMID: 36224375 PMCID: PMC9678793 DOI: 10.1038/s41366-022-01210-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity would have heightened cardiovascular risk compared to children of normal BMI women, and that the UPBEAT intervention would mitigate this risk. SUBJECTS/METHODS Children were recruited from one UPBEAT trial centre. Cardiovascular measures included blood pressure, echocardiographic assessment of cardiac function and dimensions, carotid intima-media thickness and heart rate variability (HRV) by electrocardiogram. RESULTS Compared to offspring of normal BMI women (n = 51), children of women with obesity from the trial standard care arm (n = 39) had evidence of cardiac remodelling including increased interventricular septum (IVS; mean difference 0.04 cm; 95% CI: 0.018 to 0.067), posterior wall (PW; 0.03 cm; 0.006 to 0.062) and relative wall thicknesses (RWT; 0.03 cm; 0.01 to 0.05) following adjustment. Randomisation of women with obesity to the intervention arm (n = 31) prevented this cardiac remodelling (intervention effect; mean difference IVS -0.03 cm (-0.05 to -0.008); PW -0.03 cm (-0.05 to -0.01); RWT -0.02 cm (-0.04 to -0.005)). Children of women with obesity (standard care arm) compared to women of normal BMI also had elevated minimum heart rate (7 bpm; 1.41 to 13.34) evidence of early diastolic dysfunction (e prime) and increased sympathetic nerve activity index by HRV analysis. CONCLUSIONS Maternal obesity was associated with left ventricular concentric remodelling in 3-year-old offspring. Absence of remodelling following the maternal intervention infers in utero origins of cardiac remodelling. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.
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Affiliation(s)
- Paul D Taylor
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK.
| | - Haotian Gu
- BHF Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Hannah Saunders
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Federico Fiori
- Department of Child and Adolescent Psychiatry, IOPPN Kings College London, London, UK
| | - Kathryn V Dalrymple
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Priyanka Sethupathi
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Liana Yamanouchi
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Faith Miller
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Bethany Jones
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Matias C Vieira
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Claire Singh
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Annette Briley
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Paul T Seed
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Dharmintra Pasupathy
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paramala J Santosh
- Department of Child and Adolescent Psychiatry, IOPPN Kings College London, London, UK
| | - Alan M Groves
- Department of Pediatrics, Division of Newborn Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish D Sinha
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
- BHF Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
- Department of Paediatric Nephrology, Evelina London Children's Hospital, King's College London, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Philip J Chowienczyk
- BHF Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Lucilla Poston
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
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22
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Lalayiannis AD, Crabtree NJ, Ferro CJ, Wheeler DC, Duncan ND, Smith C, Popoola J, Varvara A, Mitsioni A, Kaur A, Sinha MD, Biassoni L, McGuirk SP, Mortensen KH, Milford DV, Long J, Leonard MD, Fewtrell M, Shroff R. Bone Mineral Density and Vascular Calcification in Children and Young Adults With CKD 4 to 5 or on Dialysis. Kidney Int Rep 2022; 8:265-273. [PMID: 36815116 PMCID: PMC9939315 DOI: 10.1016/j.ekir.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Older adults with chronic kidney disease (CKD) can have low bone mineral density (BMD) with concurrent vascular calcification. Mineral accrual by the growing skeleton may protect young people with CKD from extraosseous calcification. Our hypothesis was that children and young adults with increasing BMD do not develop vascular calcification. Methods This was a multicenter longitudinal study in children and young people (5-30 years) with CKD stages 4 to 5 or on dialysis. BMD was assessed by tibial peripheral quantitative computed tomography (pQCT) and lumbar spine dual-energy X-ray absorptiometry (DXA). The following cardiovascular imaging tests were undertaken: cardiac computed tomography for coronary artery calcification (CAC), ultrasound for carotid intima media thickness z-score (cIMTz), pulse wave velocity z-score (PWVz), and carotid distensibility for arterial stiffness. All measures are presented as age-adjusted and sex-adjusted z-scores. Results One hundred participants (median age 13.82 years) were assessed at baseline and 57 followed up after a median of 1.45 years. Trabecular BMD z-score (TrabBMDz) decreased (P = 0.01), and there was a nonsignificant decrease in cortical BMD z-score (CortBMDz) (P = 0.09). Median cIMTz and PWVz showed nonsignificant increase (P = 0.23 and P = 0.19, respectively). The annualized increase in TrabBMDz (ΔTrabBMDz) was an independent predictor of cIMTz increase (R 2 = 0.48, β = 0.40, P = 0.03). Young people who demonstrated statural growth (n = 33) had lower ΔTrabBMDz and also attenuated vascular changes compared with those with static growth (n = 24). Conclusion This hypothesis-generating study suggests that children and young adults with CKD or on dialysis may develop vascular calcification even as their BMD increases. A presumed buffering capacity of the growing skeleton may offer some protection against extraosseous calcification.
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Affiliation(s)
- Alexander D. Lalayiannis
- Pediatric Nephrology, Birmingham Women’s and Children’s Hospitals, National Health Service Foundation Trust, Birmingham, UK; University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Nephrology, Birmingham Children’s Hospital, Birmingham, UK
- Correspondence: Alexander D. Lalayiannis, Nephrology Department, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Nicola J. Crabtree
- Densitometry Department, Birmingham Women’s and Children’s Hospitals National Health Service, Foundation Trust, Birmingham, UK
| | | | - David C. Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Neill D. Duncan
- Imperial College Healthcare National Health Service Trust, Renal and Transplant Center, London, UK
| | - Colette Smith
- Institute of Global Helath, University College London, London, UK
| | - Joyce Popoola
- St. George’s University Hospital National Health Service Foundation Trust, London, UK
| | - Askiti Varvara
- Department of Pediatric Nephrology, “P & A Kyriakou” Children’s Hospital, Athens, Greece
| | - Andromachi Mitsioni
- Department of Pediatric Nephrology, “P & A Kyriakou” Children’s Hospital, Athens, Greece
| | - Amrit Kaur
- Pediatric Nephrology, Manchester University National Health Service Foundation Trust, Manchester, UK
| | - Manish D. Sinha
- Pediatric Nephrology, Evelina Children’s Hospital, London, UK
| | - Lorenzo Biassoni
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Simon P. McGuirk
- Radiology Department, Birmingham Women’s and Children’s Hospitals National Health Service Foundation Trust, Birmingham, UK
| | - Kristian H. Mortensen
- Department of Cardiac Imaging, University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | | | - Jin Long
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Mary D. Leonard
- Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mary Fewtrell
- University College London Great Ormond Street Institute of Child Health, Population Policy and Practice, Childhood Nutrition Research Center, London, UK
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Great Ormond Street Hospital, London, UK
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23
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Bierzynska A, Bull K, Miellet S, Dean P, Neal C, Colby E, McCarthy HJ, Hegde S, Sinha MD, Bugarin Diz C, Stirrups K, Megy K, Mapeta R, Penkett C, Marsh S, Forrester N, Afzal M, Stark H, BioResource NIHR, Williams M, Welsh GI, Koziell AB, Hartley PS, Saleem MA. Exploring the relevance of NUP93 variants in steroid-resistant nephrotic syndrome using next generation sequencing and a fly kidney model. Pediatr Nephrol 2022; 37:2643-2656. [PMID: 35211795 PMCID: PMC9489583 DOI: 10.1007/s00467-022-05440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Variants in genes encoding nuclear pore complex (NPC) proteins are a newly identified cause of paediatric steroid-resistant nephrotic syndrome (SRNS). Recent reports describing NUP93 variants suggest these could be a significant cause of paediatric onset SRNS. We report NUP93 cases in the UK and demonstrate in vivo functional effects of Nup93 depletion in a fly (Drosophila melanogaster) nephrocyte model. METHODS Three hundred thirty-seven paediatric SRNS patients from the National cohort of patients with Nephrotic Syndrome (NephroS) were whole exome and/or whole genome sequenced. Patients were screened for over 70 genes known to be associated with Nephrotic Syndrome (NS). D. melanogaster Nup93 knockdown was achieved by RNA interference using nephrocyte-restricted drivers. RESULTS Six novel homozygous and compound heterozygous NUP93 variants were detected in 3 sporadic and 2 familial paediatric onset SRNS characterised histologically by focal segmental glomerulosclerosis (FSGS) and progressing to kidney failure by 12 months from clinical diagnosis. Silencing of the two orthologs of human NUP93 expressed in D. melanogaster, Nup93-1, and Nup93-2 resulted in significant signal reduction of up to 82% in adult pericardial nephrocytes with concomitant disruption of NPC protein expression. Additionally, nephrocyte morphology was highly abnormal in Nup93-1 and Nup93-2 silenced flies surviving to adulthood. CONCLUSION We expand the spectrum of NUP93 variants detected in paediatric onset SRNS and demonstrate its incidence within a national cohort. Silencing of either D. melanogaster Nup93 ortholog caused a severe nephrocyte phenotype, signaling an important role for the nucleoporin complex in podocyte biology. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Agnieszka Bierzynska
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
| | - Katherine Bull
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sara Miellet
- Department of Life and Environmental Science, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB England, UK
- Illawarra Health and Medical Research Institute, Molecular Horizons and School of Medicine, University of Wollongong, Wollongong, Australia
| | - Philip Dean
- Bristol Genetics Laboratory, North Bristol National Health Service Trust, Bristol, UK
| | - Chris Neal
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
| | - Elizabeth Colby
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
| | - Hugh J. McCarthy
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
- School of Medicine, University of Sydney and Children’s Hospital at Westmead, Westmead, Australia
| | - Shivaram Hegde
- Children’s Kidney Centre, University Hospital of Wales, Cardiff, UK
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St, Thomas’ Hospital, London, UK
| | - Carmen Bugarin Diz
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 7EH UK
| | - Kathleen Stirrups
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Karyn Megy
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Rutendo Mapeta
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA UK
| | - Chris Penkett
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Sarah Marsh
- Bristol Genetics Laboratory, North Bristol National Health Service Trust, Bristol, UK
| | - Natalie Forrester
- Illawarra Health and Medical Research Institute, Molecular Horizons and School of Medicine, University of Wollongong, Wollongong, Australia
| | - Maryam Afzal
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
| | - Hannah Stark
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - NIHR BioResource
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Maggie Williams
- Bristol Genetics Laboratory, North Bristol National Health Service Trust, Bristol, UK
| | - Gavin I. Welsh
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
| | - Ania B. Koziell
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St, Thomas’ Hospital, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 7EH UK
| | - Paul S. Hartley
- Department of Life and Environmental Science, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB England, UK
| | - Moin A. Saleem
- Bristol Renal and Children’s Renal Unit, Bristol Medical School, University of Bristol, Whitson Street, Bristol, BS1 3NY UK
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24
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Sinha MD, Azukaitis K, Sladowska-Kozłowska J, Bårdsen T, Merkevicius K, Karlsen Sletten IS, Obrycki Ł, Pac M, Fernández-Aranda F, Bjelakovic B, Jankauskiene A, Litwin M. Prevalence of left ventricular hypertrophy in children and young people with primary hypertension: Meta-analysis and meta-regression. Front Cardiovasc Med 2022; 9:993513. [PMID: 36386367 PMCID: PMC9659762 DOI: 10.3389/fcvm.2022.993513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is the main marker of HMOD in children and young people (CYP). We aimed to assess the prevalence of LVH and its determinants in CYP with primary hypertension (PH). METHODS A meta-analysis of prevalence was performed. A literature search of articles reporting LVH in CYP with PH was conducted in Medline, Embase, and Cochrane databases. Studies with a primary focus on CYP (up to 21 years) with PH were included. Meta-regression was used to analyze factors explaining observed heterogeneity. RESULTS The search yielded a total of 2,200 articles, 153 of those underwent full-text review, and 47 reports were included. The reports evaluated 51 study cohorts including 5,622 individuals, 73% male subjects, and a mean age of 13.6 years. LVH was defined as left ventricle mass index (LVMI) ≥ 95th percentile in 22 (47%), fixed cut-off ≥38.6 g/m2.7 in eight (17%), sex-specific fixed cut-off values in six (13%), and miscellaneously in others. The overall prevalence of LVH was 30.5% (95% CI 27.2-33.9), while heterogeneity was high (I 2 = 84%). Subgroup analysis including 1,393 individuals (76% male subjects, mean age 14.7 years) from pediatric hypertension specialty clinics and LVH defined as LVMI ≥95th percentile only (19 study cohorts from 18 studies), reported prevalence of LVH at 29.9% (95% CI 23.9 to 36.3), and high heterogeneity (I 2 = 84%). Two studies involving patients identified through community screening (n = 1,234) reported lower LVH prevalence (21.5%). In the meta-regression, only body mass index (BMI) z-score was significantly associated with LVH prevalence (estimate 0.23, 95% CI 0.08-0.39, p = 0.004) and accounted for 41% of observed heterogeneity, but not age, male percentage, BMI, or waist circumference z-score. The predominant LVH phenotype was eccentric LVH in patients from specialty clinics (prevalence of 22% in seven studies with 779 participants) and one community screening study reported the predominance of concentric LVH (12%). CONCLUSION Left ventricular hypertrophy is evident in at least one-fifth of children and young adults with PH and in nearly a third of those referred to specialty clinics with a predominant eccentric LVH pattern in the latter. Increased BMI is the most significant risk association for LVH in hypertensive youth.
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Affiliation(s)
- Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
- Kings College London, London, United Kingdom
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Tonje Bårdsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kajus Merkevicius
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Łukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Michał Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Fernando Fernández-Aranda
- University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Bojko Bjelakovic
- Clinic of Pediatrics, Clinical Center, Nis, Serbia
- Medical Faculty, University of Nis, Nis, Serbia
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
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25
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Lucas I, Puteikis K, Sinha MD, Litwin M, Merkevicius K, Azukaitis K, Rus R, Pac M, Obrycki L, Bårdsen T, Śladowska-Kozłowska J, Sagsak E, Lurbe E, Jiménez-Murcia S, Jankauskiene A, Fernández-Aranda F. Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review. Front Cardiovasc Med 2022; 9:973793. [PMID: 36337900 PMCID: PMC9631488 DOI: 10.3389/fcvm.2022.973793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/04/2022] [Indexed: 01/04/2024] Open
Abstract
Arterial hypertension (AH) among adults is known to be associated with worse cognitive outcomes. Similarly, children and adolescents with AH could be expected to underperform during neuropsychological evaluations when compared with healthy peers. Our aims were to review the existing literature on cognitive functioning among children and adolescents with primary AH and to identify what additional evidence may be needed to substantiate the impact of hypertension on poor cognitive outcomes in this population. We conducted a systematic review of articles in PubMed and Web of Science published before 17 January 2022, reporting on cognitive testing among children and adolescents with primary AH. From 1,316 records, 13 were included in the review-7 used battery-testing while other employed indirect measures of cognitive functions. Most of the studies reported worse results among individuals with AH. Results of two prospective trials suggested that cognitive functioning may improve after starting antihypertensive treatment. Ambulatory blood pressure monitoring was shown to be more strongly related to cognitive testing results than office measures of blood pressure. Significant confounders, namely obesity and sleep apnea, were identified throughout the studies. Our review indicates that evidence relating AH with poor cognitive functioning among youth is usually based on indirect measures of executive functions (e.g., questionnaires) rather than objective neuropsychological tests. Future prospective trials set to test different cognitive domains in children and adolescents undergoing treatment for AH are endorsed and should consider using standardized neuropsychological batteries as well as adjust the assessing results for obesity and sleep disorders.
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Affiliation(s)
- Ignacio Lucas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Karolis Azukaitis
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rina Rus
- Department of Pediatric Nephrology, Children’s Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Michał Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Tonje Bårdsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Elif Sagsak
- University of Health Sciences Turkey, Clinic of Pediatric Endocrinology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Augustina Jankauskiene
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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26
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Haseler E, Singh C, Newton J, Melhem N, Sinha MD. Demographics of childhood hypertension in the UK: a report from the Southeast England. J Hum Hypertens 2022:10.1038/s41371-022-00732-7. [PMID: 35933484 DOI: 10.1038/s41371-022-00732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
Abstract
We aimed to describe hypertensive phenotype and demographic characteristics in children and adolescents referred to our paediatric hypertension service. We compared age, ethnicity and BMI in primary hypertension (PH) compared to those with secondary hypertension (SH) and white coat hypertension (WCH). Demographic and anthropometric data were collected for children and adolescents up to age 18 referred to our service for evaluation of suspected hypertension over a 6 year period. Office blood pressure (BP) and out of office BP were performed. Patients were categorised as normotensive (normal office and out of office BP), WCH (abnormal office BP, normal out of office BP), PH (both office and out of office BP abnormal, no underlying cause identified) and SH (both office and out of office BP abnormal, with a secondary cause identified). 548 children and adolescents with mean ± SD age of 10.1 ± 5.8 years and 58.2% girls. Fifty seven percent (n = 314) were hypertensive; of these, 47 (15%), 84 (27%) and 183 (58%) had WCH, PH and SH, respectively. SH presented throughout childhood, whereas PH and WCH peaked in adolescence. Non-White ethnicity was more prevalent within those diagnosed with PH than both the background population and those diagnosed with SH. Higher BMI z-scores were observed in those with PH compared to SH. Hypertensive children <6 years are most likely to have SH and have negligible rates of WCH and PH. PH accounted for 27% of hypertension diagnoses in children and adolescents, with the highest prevalence in adolescence, those of non-White Ethnicity and with excess weight.
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Affiliation(s)
- Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | | | - Joanna Newton
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK. .,Kings College London, London, UK.
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27
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Plumb L, Magadi W, Casula A, Reynolds BC, Convery M, Haq S, Hegde S, Lunn A, Malina M, Morgan H, Muorah M, Tyerman K, Sinha MD, Wallace D, Inward C, Marks S, Nitsch D, Medcalf J. Advanced chronic kidney disease among UK children. Arch Dis Child 2022; 107:archdischild-2021-323686. [PMID: 35732469 DOI: 10.1136/archdischild-2021-323686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The UK Renal Registry currently collects information on UK children with kidney failure requiring long-term kidney replacement therapy (KRT), which supports disease surveillance and auditing of care and outcomes; however, data are limited on children with chronic kidney disease (CKD) not on KRT. METHODS In March 2020, all UK Paediatric Nephrology centres submitted data on children aged <16 years with severely reduced kidney function as of December 2019, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m2. RESULTS In total, 1031 children had severe CKD, the majority of whom (80.7%) were on KRT. The overall prevalence was 81.2 (95% CI 76.3 to 86.3) per million of the age-related population. CONCLUSIONS The prevalence of severe CKD among UK children is largely due to a high proportion of children on long-term KRT. Expanding data capture to include children with CKD before reaching failure will provide greater understanding of the CKD burden in childhood.
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Affiliation(s)
- Lucy Plumb
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Winnie Magadi
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Ben C Reynolds
- Department of Paediatric Nephrology, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Mairead Convery
- Department of Paediatric Nephrology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Shuman Haq
- Department of Paediatric Nephrology, Southampton Children's Hospital, Southampton, UK
| | - Shivaram Hegde
- Department of Paediatric Nephrology, University Hospital of Wales, Cardiff, UK
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michal Malina
- National Renal Complement Therapeutics Centre, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mordi Muorah
- Department of Paediatric Nephrology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kay Tyerman
- Department of Paediatric Nephrology, Leeds Children's Hospital, Leeds, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Dean Wallace
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Carol Inward
- Department of Paediatric Nephrology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Stephen Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - James Medcalf
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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28
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Chong C, Hamza Y, Tan YW, Paul A, Garriboli M, Wright AJ, Olsburgh J, Taylor C, Sinha MD, Mishra P, Taghizadeh A. Long-term urology outcomes of anorectal malformation. J Pediatr Urol 2022; 18:150.e1-150.e6. [PMID: 35283020 DOI: 10.1016/j.jpurol.2022.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Urological problems are a recognised feature of anorectal malformation (ARM). Previous assumptions of favourable long-term urinary outcomes are being challenged. OBJECTIVE We hypothesised that urinary tract problems are common in ARM and frequently persist into adulthood. We retrospectively reviewed long-term renal and bladder outcomes in ARM patients. STUDY DESIGN Patients with ARM born between 1984-2005 were identified from electronic hospital databases. Their case notes were reviewed. Renal outcomes included serum creatinine and the need for renal replacement therapy. Bladder outcomes included symptom review, bladder medication, need for intermittent catheterisation, videourodynamics and whether the patient had undergone augmentation cystoplasty. RESULT (TABLE 1): The case notes of 50 patients were reviewed. The median age at last follow up was 18 years (range 12-34 years). The level of fistula was noted to be high in 17 patients, intermediate in eight, and low in 10. Four had cloaca. Congenital urological abnormalities were present in 25 (50%). An abnormal spinal cord was present in 22 (44%) patients. VACTERL association occurred in 27 (54%). Chronic kidney disease stage II or above was found in 14 (28%) patients, of whom four required a renal transplant. Abnormal bladder outcomes were found in 39 (78%) patients. Augmentation cystoplasty with Mitrofanoff had been performed in 12. Of those who had not undergone cystoplasty, 17 had urinary symptoms, including urinary incontinence in 12. Of the 39 patients with abnormal bladder outcome, 19 (49%) did not have a spinal cord abnormality. There was no significant statistical association between level of ARM and abnormal renal outcome or presence of bladder abnormality. DISCUSSION Adverse renal and bladder outcomes are common in our cohort of young people with ARM with a significantly higher incidence compared with current literature. We did not demonstrate an association between level of ARM or presence of spinal cord anomaly with persistent bladder problems. Congenital urological anomalies are more common in those who later have an abnormal renal outcome. Although this difference is statistically significant, one fifth of patients born with anatomically normal upper tracts develop reduced renal function, implying an important acquired component. CONCLUSION Bladder problems and reduced renal function affect a significant proportion of young adults with ARM. Neither adverse outcome is reliably predicted from ARM level, congenital urological anomaly or spinal cord anomaly. We advise continued long-term bladder and kidney follow-up for all patients with ARM.
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Affiliation(s)
- Clara Chong
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Paediatric Surgery, Evelina London Children's Hospital, London, United Kingdom.
| | - Yaser Hamza
- Kings College London, London, United Kingdom
| | - Yew Wei Tan
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Anne J Wright
- Department of Paediatric Nephrourology, Evelina London Children's Hospital, London, United Kingdom
| | - Jonathon Olsburgh
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claire Taylor
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Manish D Sinha
- Kings College London, London, United Kingdom; Department of Paediatric Nephrourology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Arash Taghizadeh
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Kings College London, London, United Kingdom
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29
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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] [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: 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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Printza N, Dotis J, Sinha MD, Leifheit-Nestler M. Editorial: Mineral and Bone Disorder in CKD. Front Pediatr 2022; 10:856656. [PMID: 35252071 PMCID: PMC8894607 DOI: 10.3389/fped.2022.856656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nikoleta Printza
- Pediatric Nephrology Unit, 1st Pediatric Department, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
| | - John Dotis
- Pediatric Nephrology Unit, 1st Pediatric Department, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, London, United Kingdom
| | - Maren Leifheit-Nestler
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hanover, Germany
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31
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Deogaonkar G, Sinha MD, Jones M, Calder F, Karunanithy N, Qureshi SA. Percutaneous Venous Reconstruction for Central Thrombosis-Associated Chylothorax: A Safe and Efficacious Option. JACC Case Rep 2021; 3:1569-1575. [PMID: 34729502 PMCID: PMC8543144 DOI: 10.1016/j.jaccas.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/05/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Central thrombosis–associated chylothorax is underrecognized in children and frequently refractory to conservative management. Central venous catheterizations are the predominate cause. We present 3 cases highlighting endovascular techniques used to treat persistent chylous effusions. (Level of Difficulty: Advanced.)
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Key Words
- CT, computed tomography
- CTaC, central thrombosis–associated chylothorax
- CVT, central vein thrombosis
- IVC, inferior vena cava
- MCT, medium-chain triglyceride
- MPA, main pulmonary artery
- MRI, magnetic resonance imaging
- RPA, right pulmonary artery
- SVC, superior vena cava
- TPN, total parenteral nutrition
- central line
- central vein obstruction
- chylothorax
- chylous effusion
- endovenous reconstruction
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Affiliation(s)
- Ganesh Deogaonkar
- Department of Interventional Radiology, Evelina London Children's Hospital, London, United Kingdom
| | - Manish D Sinha
- Department of Nephrology, Evelina London Children's Hospital, London, United Kingdom
| | - Matthew Jones
- Department of Pediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Francis Calder
- Department of Renal Transplantation, Evelina London Children's Hospital. London, United Kingdom
| | - Narayan Karunanithy
- Department of Interventional Radiology, Evelina London Children's Hospital, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Shakeel A Qureshi
- Department of Pediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
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32
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Fischer DC, Smith C, De Zan F, Bacchetta J, Bakkaloglu SA, Agbas A, Anarat A, Aoun B, Askiti V, Azukaitis K, Bayazit A, Bulut IK, Canpolat N, Borzych-Dużałka D, Duzova A, Habbig S, Krid S, Licht C, Litwin M, Obrycki L, Paglialonga F, Rahn A, Ranchin B, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Stefanidis CJ, Vidal E, Yilmaz A, Fischbach M, Schaefer F, Schmitt CP, Shroff R. Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional Hemodialysis in Children: The HDF, Hearts and Heights (3H) Study. Kidney Int Rep 2021; 6:2358-2370. [PMID: 34514197 PMCID: PMC8418977 DOI: 10.1016/j.ekir.2021.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/23/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
Background Patients on dialysis have a high burden of bone-related comorbidities, including fractures. We report a post hoc analysis of the prospective cohort study HDF, Hearts and Heights (3H) to determine the prevalence and risk factors for chronic kidney disease-related bone disease in children on hemodiafiltration (HDF) and conventional hemodialysis (HD). Methods The baseline cross-sectional analysis included 144 children, of which 103 (61 HD, 42 HDF) completed 12-month follow-up. Circulating biomarkers of bone formation and resorption, inflammatory markers, fibroblast growth factor-23, and klotho were measured. Results Inflammatory markers interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein were lower in HDF than in HD cohorts at baseline and at 12 months (P < .001). Concentrations of bone formation (bone-specific alkaline phosphatase) and resorption (tartrate-resistant acid phosphatase 5b) markers were comparable between cohorts at baseline, but after 12-months the bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio increased in HDF (P = .004) and was unchanged in HD (P = .44). On adjusted analysis, the bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio was 2.66-fold lower (95% confidence interval, −3.91 to −1.41; P < .0001) in HD compared with HDF. Fibroblast growth factor-23 was comparable between groups at baseline (P = .52) but increased in HD (P < .0001) and remained unchanged in HDF (P = .34) at 12 months. Klotho levels were similar between groups and unchanged during follow-up. The fibroblast growth factor-23/klotho ratio was 3.86-fold higher (95% confidence interval, 2.15–6.93; P < .0001) after 12 months of HD compared with HDF. Conclusion Children on HDF have an attenuated inflammatory profile, increased bone formation, and lower fibroblast growth factor-23/klotho ratios compared with those on HD. Long-term studies are required to determine the effects of an improved bone biomarker profile on fracture risk and cardiovascular health.
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Affiliation(s)
| | - Colette Smith
- Pediatric Nephrology Unit, Institute of Global Health, University College London, London, UK
| | - Francesca De Zan
- Pediatric Nephrology Unit, University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Justine Bacchetta
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | | | - Ayse Agbas
- Pediatric Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ali Anarat
- Pediatric Nephrology Unit, Cukurova University, Adana, Turkey
| | - Bilal Aoun
- Pediatric Nephrology Unit, Armand Trousseau Hospital, Paris, France
| | - Varvara Askiti
- Pediatric Nephrology Unit, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Karolis Azukaitis
- Pediatric Nephrology Unit, Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aysun Bayazit
- Pediatric Nephrology Unit, Cukurova University, Adana, Turkey
| | - Ipek Kaplan Bulut
- Pediatric Nephrology Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Nur Canpolat
- Pediatric Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Ali Duzova
- Pediatric Nephrology Unit, Hacettepe University, Ankara, Turkey
| | - Sandra Habbig
- Pediatric Nephrology Unit, University Hospital Cologne, Cologne, Germany
| | - Saoussen Krid
- Pediatric Nephrology Unit, Hôpital Necker-Enfants Malades, Paris, France
| | - Christoph Licht
- Pediatric Nephrology Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mieczyslaw Litwin
- Pediatric Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Pediatric Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Fabio Paglialonga
- Pediatric Nephrology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anja Rahn
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | - Charlotte Samaille
- Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire Lille, Lille, France
| | - Mohan Shenoy
- Pediatric Nephrology Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Manish D Sinha
- Pediatric Nephrology Unit, Kings College London Evelina London Children's Hospital, London, UK
| | | | | | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Alev Yilmaz
- Pediatric Nephrology Unit, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | | | - Franz Schaefer
- Pediatric Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Claus Peter Schmitt
- Pediatric Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Rukshana Shroff
- Pediatric Nephrology Unit, University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
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Hamilton A, Plumb L, Casula A, Sinha MD. Erratum. Nephrol Dial Transplant 2021; 36:gfab010. [PMID: 34118152 DOI: 10.1093/ndt/gfab010] [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: 11/12/2022] Open
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34
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Oni L, Gritzfeld JF, Jones C, Sinha MD, Wallace D, Stack M, Kurt-Sukur ED, Quinlan C, Ruggiero B, Raja M, Tullus K. Comment on: European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative. Rheumatology (Oxford) 2021; 60:e179-e180. [PMID: 32337557 DOI: 10.1093/rheumatology/keaa159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Louise Oni
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool and Liverpool Health Partners
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool
| | - Jenna F Gritzfeld
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool and Liverpool Health Partners
| | - Caroline Jones
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London
| | - Dean Wallace
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Maria Stack
- Department of Paediatric Nephrology, Children's Health Ireland, Dublin, Ireland
| | - Eda Didem Kurt-Sukur
- Department of Paediatric Nephrology, Dr Sami Ulus Children's Hospital, Ankara, Turkey
| | - Catherine Quinlan
- Department of Paediatric Nephrology, The Royal Children's Hospital, Melbourne, Australia
| | - Barbara Ruggiero
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Maduri Raja
- Department of Paediatric Nephrology, Southampton Children's Hospital, Southampton
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street NHS Foundation Trust Hospital, London, UK
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35
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Kim JS, Marlais M, Balasubramanian R, Muorah M, Inward C, Smith GC, Reynolds BC, Yadav P, Morgan H, Shenoy M, Tse Y, Hussain F, Grylls S, Kessaris N, Sinha MD, Marks SD. UK national study of barriers to renal transplantation in children. Arch Dis Child 2021; 106:384-386. [PMID: 32241783 DOI: 10.1136/archdischild-2019-318272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/19/2020] [Indexed: 11/04/2022]
Abstract
AIMS To investigate access to paediatric renal transplantation and examine potential barriers within the process. METHODS Cross-sectional, multicentre, observational study where paediatric nephrology centres in the UK were requested to provide data on transplantation plans for all children (<18 years) with end-stage kidney disease (ESKD). RESULTS 308 children with ESKD were included in this study from 12 out of 13 UK paediatric nephrology centres. 139 (45%) were being prepared for living donor transplantation and 82 (27%) were listed for deceased donor transplantation. The most common cited factors delaying transplantation from occurring in children were disease factors (36%), donor availability (27%) and size of the child (20%). Psychosocial factors were listed as a barrier in 19% of children. CONCLUSIONS In this study we have documented the main barriers to renal transplantation in children. Some identified factors may be modifiable through local or national intervention, including donor availability and patient psychosocial factors.
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Affiliation(s)
- Ji Soo Kim
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Matko Marlais
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Mordi Muorah
- Paediatric Nephrology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Carol Inward
- Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
| | - Graham C Smith
- Paediatric Nephrology, Children's Hospital for Wales, Cardiff, UK
| | - Ben C Reynolds
- Paediatric Renal Unit, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Pallavi Yadav
- Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Henry Morgan
- Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mohan Shenoy
- Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Yincent Tse
- Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Farida Hussain
- Paediatric Nephrology, Nottingham Children's Hospital, Nottingham, UK
| | - Sarah Grylls
- Paediatric Nephrology, Southampton Children's Hospital, Southampton, UK
| | - Nicos Kessaris
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Transplantation, Evelina London Children's Hospital, London, UK
| | - Manish D Sinha
- Paediatric Nephrology, Evelina London Children's Hospital, London, UK.,Child Health Clinical Academic Group, King's College London, London, UK
| | - Stephen D Marks
- Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
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Gu H, Singh C, Li Y, Simpson J, Chowienczyk P, Sinha MD. Early ventricular contraction in children with primary hypertension relates to left ventricular mass. J Hypertens 2021; 39:711-717. [PMID: 33201051 DOI: 10.1097/hjh.0000000000002699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS In hypertensive adults, first-phase ejection fraction (EF1), a measure of early ventricular contraction is reduced and associated with prolonged systolic contraction and diastolic dysfunction. Whether this is true in children with primary hypertension is unknown. METHODS Echocardiography was performed in 47 normotensive and 81 hypertensive children. Hypertensive children were stratified according to tertiles of LVMi (g/m2.7). EF1 was calculated from the fraction of LV volume ejected up to the time of peak aortic flow. E/e' was used as a measure of diastolic function. Myocardial wall stress (MWS) was calculated in a subsample of children from LV volumes and central aortic pressure. Time to onset of relaxation (TOR) was defined as time to peak MWS over ejection time. RESULTS Normotensive and hypertensive children were of similar age. Hypertensive children in tertiles 2 and 3 of LVMi had higher BMI z-score than normotensives. EF1 was significantly increased in hypertensive children in tertile 1 compared with normotensive children (P < 0.001), whereas in those in tertile 3, it was significantly lower than in normotensive children (P < 0.001). EF1 was negatively associated with LVMi (β = -0.505, P < 0.001), LVM (β = -0.531, P = 0.001) and E/e' ratio (β = -0.409, P < 0.001); in children who had MWS measured, TOR was negatively associated with EF1 (β = -0.303, P = 0.007) and positively associated with E/e' (β = 0.459, P < 0.001). CONCLUSION EF1 is preserved or enhanced in hypertensive children with similar LVMi to normotensive children but is increasingly reduced in those with greater LVMi. This reduction of EF1 is associated with prolonged myocardial wall stress and reduced diastolic function.
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Affiliation(s)
- Haotian Gu
- King's College London British Heart Foundation Centre
| | | | - Ye Li
- King's College London British Heart Foundation Centre
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | | | - Manish D Sinha
- King's College London British Heart Foundation Centre
- Department of Paediatric Nephrology
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Hessey E, Melhem N, Alobaidi R, Ulrich E, Morgan C, Bagshaw SM, Sinha MD. Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years. Front Pediatr 2021; 9:648587. [PMID: 33791260 PMCID: PMC8005629 DOI: 10.3389/fped.2021.648587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is an important risk factor for increased morbidity and mortality during hospitalization. Over the past decade, accumulated data on children and young people indicates that acute episodes of kidney dysfunction can have lasting consequences on multiple organ systems and health outcomes. To date, there are no guidelines for follow-up of surviving children that may be at risk of long-term sequelae following AKI in the PICU. This narrative review aims to describe literature from the last 5 years on the risk of medium and long-term kidney and non-kidney outcomes after AKI in the PICU. More specifically, we will focus on outcomes in children and young people following AKI in the general PICU population and children undergoing cardiac surgery. These outcomes include mortality, hypertension, proteinuria, chronic kidney disease, and healthcare utilization. We also aim to highlight current gaps in knowledge in medium and long-term outcomes in this pediatric population. We suggest a framework for future research to develop evidence-based guidelines for follow-up of children surviving an episode of critical illness and AKI.
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Affiliation(s)
- Erin Hessey
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nabil Melhem
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom
| | - Rashid Alobaidi
- Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
| | - Emma Ulrich
- Department of Pediatric Nephrology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Catherine Morgan
- Department of Pediatric Nephrology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry and Alberta Health Services—Edmonton Zone, University of Alberta, Edmonton, AB, Canada
- Alberta Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Manish D. Sinha
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom
- King's College London, London, United Kingdom
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Plumb LA, Sinha MD, Casula A, Inward CD, Marks SD, Caskey FJ, Ben-Shlomo Y. Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom. Clin J Am Soc Nephrol 2021; 16:194-203. [PMID: 33468533 PMCID: PMC7863652 DOI: 10.2215/cjn.11020720] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/07/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates. RESULTS Analysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model. CONCLUSIONS Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.
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Affiliation(s)
- Lucy A. Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom,United Kingdom Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ National Health Service Foundation Trust, London, United Kingdom,King's British Heart Foundation Centre, King's College London, London, United Kingdom
| | - Anna Casula
- United Kingdom Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Carol D. Inward
- Department of Paediatric Nephrology, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom,Department of Renal Medicine, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom,The National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
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Picone DS, Schultz MG, Armstrong MK, Black JA, Bos WJW, Chen CH, Cheng HM, Cremer A, Dwyer N, Hughes AD, Kim HL, Lacy PS, Laugesen E, Liang F, Ohte N, Okada S, Omboni S, Ott C, Pereira T, Pucci G, Schmieder RE, Sinha MD, Stouffer GA, Takazawa K, Roberts-Thomson P, Wang JG, Weber T, Westerhof BE, Williams B, Sharman JE. Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements. Hypertension 2021; 77:632-639. [PMID: 33390047 DOI: 10.1161/hypertensionaha.120.16109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55-72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/<80 mm Hg using cuff BP compared with invasive aortic BP as the reference. The prevalence of ISH was 24% (n=407) according to cuff BP but 38% (n=642) according to invasive aortic BP. There was fair agreement (Cohen κ, 0.36) and 72% concordance between cuff and invasive aortic BP for identifying ISH. Among the 28% of subjects (n=471) with misclassification of ISH status by cuff BP, 20% (n=96) of the difference was due to lower cuff systolic BP compared with invasive aortic systolic BP (mean, -16.4 mm Hg [95% CI, -18.7 to -14.1]), whereas 49% (n=231) was from higher cuff diastolic BP compared with invasive aortic diastolic BP (+14.2 mm Hg [95% CI, 11.5-16.9]). In conclusion, compared with invasive BP, cuff BP fails to identify ISH in a sizeable portion of older people and demonstrates the need to improve cuff BP measurements.
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Affiliation(s)
- Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Matthew K Armstrong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - J Andrew Black
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Willem Jan W Bos
- St Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands (W.J.B.).,Department of Internal Medicine, Leiden University Medical Center, the Netherlands (W.J.B.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., M.-H.C.)
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., M.-H.C.)
| | - Antoine Cremer
- Department of Cardiology/Hypertension, University Hospital of Bordeaux, France (A.C.)
| | - Nathan Dwyer
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H., B.W.)
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Hospital, South Korea (H.-L.K.)
| | - Peter S Lacy
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (E.L.)
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, China (F.L.).,Institute for Personalized Medicine, Sechenov University, Moscow, Russia (F.L.)
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan (N.O.)
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan (S. Okada)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S. Omboni).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S. Omboni)
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Telmo Pereira
- Department of Physiology, Polytechnic Institute of Coimbra, ESTES, Lousã, Portugal (T.P.)
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Manish D Sinha
- Department of Clinical Pharmacology and Department of Paediatric Nephrology, Kings College London, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (M.D.S.)
| | - George A Stouffer
- Division of Cardiology, University of North Carolina at Chapel Hill (G.A.S.)
| | - Kenji Takazawa
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Japan (K.T.)
| | - Philip Roberts-Thomson
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria (T.W.)
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands (B.E.W.)
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H., B.W.).,Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
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Grund A, Sinha MD, Haffner D, Leifheit-Nestler M. Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Chronic Kidney Disease-A Pediatric Perspective. Front Pediatr 2021; 9:702719. [PMID: 34422725 PMCID: PMC8372151 DOI: 10.3389/fped.2021.702719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/05/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular diseases (CVD) are a hallmark in pediatric patients with chronic kidney disease (CKD) contributing to an enhanced risk of all-cause and CV morbidity and mortality in these patients. The bone-derived phosphaturic hormone fibroblast growth factor (FGF) 23 progressively rises with declining kidney function to maintain phosphate homeostasis, with up to 1,000-fold increase in patients with kidney failure requiring dialysis. FGF23 is associated with the development of left ventricular hypertrophy (LVH) and thereby accounts to be a CVD risk factor in CKD. Experimentally, FGF23 directly induces hypertrophic growth of cardiac myocytes in vitro and LVH in vivo. Further, clinical studies in adult CKD have observed cardiotoxicity associated with FGF23. Data regarding prevalence and determinants of FGF23 excess in children with CKD are limited. This review summarizes current data and discusses whether FGF23 may be a key driver of LVH in pediatric CKD.
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Affiliation(s)
- Andrea Grund
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hanover, Germany.,Paediatric Research Centre, Hannover Medical School, Hanover, Germany
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Children's Hospital, London, United Kingdom
| | - Dieter Haffner
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hanover, Germany.,Paediatric Research Centre, Hannover Medical School, Hanover, Germany
| | - Maren Leifheit-Nestler
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hanover, Germany.,Paediatric Research Centre, Hannover Medical School, Hanover, Germany
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Melhem N, Rasmussen P, Joyce T, Clothier J, Reid CJD, Booth C, Sinha MD. Acute kidney injury in children with chronic kidney disease is associated with faster decline in kidney function. Pediatr Nephrol 2021; 36:1279-1288. [PMID: 33108507 PMCID: PMC8009790 DOI: 10.1007/s00467-020-04777-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/04/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate the association of acute kidney injury (AKI) with change in estimated glomerular filtration rate (eGFR) in children with advanced chronic kidney disease (CKD). METHODS Single centre, retrospective longitudinal study including all prevalent children aged 1-18 years with nondialysis CKD stages 3-5. Variables associated with CKD were analysed for their potential effect on annualised eGFR change (ΔGFR/year) following multiple regression analysis. Composite end-point including 25% reduction in eGFR or progression to kidney replacement therapy was evaluated. RESULTS Of 147 children, 116 had at least 1-year follow-up in a dedicated CKD clinic with mean age 7.3 ± 4.9 years with 91 (78.4%) and 77 (66.4%) with 2- and 3-year follow-up respectively. Mean eGFR at baseline was 29.8 ± 11.9 ml/min/1.73 m2 with 79 (68%) boys and 82 (71%) with congenital abnormalities of kidneys and urinary tract (CAKUT). Thirty-nine (33.6%) had at least one episode of AKI. Mean ΔGFR/year for all patients was - 1.08 ± 5.64 ml/min/1.73 m2 but reduced significantly from 2.03 ± 5.82 to - 3.99 ± 5.78 ml/min/1.73 m2 from youngest to oldest age tertiles (P < 0.001). There was a significant difference in primary kidney disease (PKD) (77% versus 59%, with CAKUT, P = 0.048) but no difference in AKI incidence (37% versus 31%, P = 0.85) between age tertiles. Multiple regression analysis identified age (β = - 0.53, P < 0.001) and AKI (β = - 3.2, P = 0.001) as independent predictors of ΔGFR/year. 48.7% versus 22.1% with and without AKI reached composite end-point (P = 0.01). CONCLUSIONS We report AKI in established CKD as a predictor of accelerated kidney disease progression and highlight this as an additional modifiable risk factor to reduce progression of kidney dysfunction. Graphical abstract.
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Affiliation(s)
- Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Pernille Rasmussen
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Triona Joyce
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joanna Clothier
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Christopher J D Reid
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Caroline Booth
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Kings College London, London, UK
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Garcia-Nicoletti M, Sinha MD, Savis A, Adalat S, Karunanithy N, Calder F. Silent and dangerous: catheter-associated right atrial thrombus (CRAT) in children on chronic haemodialysis. Pediatr Nephrol 2021; 36:1245-1254. [PMID: 33125532 PMCID: PMC8009777 DOI: 10.1007/s00467-020-04743-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter-associated right atrial thrombus (CRAT) is a recognised complication of central venous catheter (CVC) use for haemodialysis (HD) patients. METHODS This was a single-centre retrospective longitudinal observational study of consecutive children aged 6 months-18 years over a 7-year period receiving in-centre chronic HD. Echocardiograms as per routine cardiac surveillance were performed 6 months or earlier given clinical concerns. RESULTS Sixty-five children, 36 boys (55.4%), median (IQR) age 11.8 (5.3, 14.7) years, received HD for kidney failure with replacement therapy (KFRT). Initial modality was HD in 45 (69.2%), with CVC as initial access in 42 (93.3%) and AVF in 3 (6.7%); in the remaining 20 (30.8%) patients PD was the initial modality before switching to HD. Seven of 65 (10.8%) developed CRAT at median 2 (0.8, 8.4) months from CVC insertion, with one CRAT detected 3 days following insertion. One child had 2 episodes of CRAT and one additionally thrombosed their AVF. No patient had an underlying primary kidney disease associated with a pro-thrombotic state. Those with CRAT were younger, had more frequent CVC change and received dialysis for longer duration compared to those with no CRAT. Six episodes of CRAT (75%) received anticoagulation therapy. Infective complications were observed in 25% and catheter malfunction in 50%. Five CRAT episodes (62.5%) resulted in CVC loss. One patient died after a haemorrhagic complication of anticoagulation and sepsis, and another developed life-threatening superior vena cava obstruction syndrome. Overall mortality 14% (1/7). CONCLUSIONS This is the first report of CRAT in a paediatric HD population. There was ~ 11% incidence of CRAT in patients receiving chronic HD detected by surveillance echocardiography. Although frequently asymptomatic, CRAT is associated with serious sequelae. Anticoagulation and surveillance with expert echocardiography remain mainstays of management. Graphical abstract.
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Affiliation(s)
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, SE1 7EH UK ,Kings College London, London, UK
| | - Alexandra Savis
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, London, UK
| | - Shazia Adalat
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, SE1 7EH UK
| | - Narayan Karunanithy
- Department of Intervention Radiology, Evelina London Children’s Hospital, London, UK ,School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Francis Calder
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, SE1 7EH, UK. .,Department of Paediatric Transplantation, Evelina London Children's Hospital, London, UK.
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Plumb L, Boother EJ, Caskey FJ, Sinha MD, Ben-Shlomo Y. The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis. PLoS One 2020; 15:e0244709. [PMID: 33382793 PMCID: PMC7774987 DOI: 10.1371/journal.pone.0244709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When detected early, inexpensive measures can slow chronic kidney disease progression to kidney failure which, for children, confers significant morbidity and impacts growth and development. Our objective was to determine the incidence of late presentation of childhood chronic kidney disease and its associated risk factors. METHODS We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library and CINAHL, grey literature and registry websites for observational data describing children <21 years presenting to nephrology services, with reference to late presentation (or synonyms thereof). Independent second review of eligibility, data extraction, and risk of bias was undertaken. Meta-analysis was used to generate pooled proportions for late presentation by definition and investigate risk factors. Meta-regression was undertaken to explore heterogeneity. RESULTS Forty-five sources containing data from 30 countries were included, comprising 19,339 children. Most studies (37, n = 15,772) described children first presenting in kidney failure as a proportion of the chronic kidney disease population (mean proportion 0.43, 95% CI 0.34-0.54). Using this definition, the median incidence was 2.1 (IQR 0.9-3.9) per million age-related population. Risk associations included non-congenital disease and older age. Studies of hospitalised patients, or from low- or middle-income countries, that had older study populations than high-income countries, had higher proportions of late presentation. CONCLUSIONS Late presentation is a global problem among children with chronic kidney disease, with higher proportions seen in studies of hospitalised children or from low/middle-income countries. Children presenting late are older and more likely to have non-congenital kidney disease than timely presenting children. A consensus definition is important to further our understanding and local populations should identify modifiable barriers beyond age and disease to improve access to care.
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Affiliation(s)
- Lucy Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- UK Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Emily J. Boother
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Arslan Z, Khurram MA, Sinha MD. Renal replacement therapy and conservative management: NICE guideline (NG 107) October 2018. Arch Dis Child Educ Pract Ed 2020; 105:352-354. [PMID: 32209597 DOI: 10.1136/archdischild-2019-316892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/01/2020] [Accepted: 03/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Zainab Arslan
- Department of Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK.,Department of Education and Professional Studies, King's College London, London, UK
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Hamilton AJ, Plumb LA, Casula A, Sinha MD. Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study. BMC Nephrol 2020; 21:492. [PMID: 33208146 PMCID: PMC7672825 DOI: 10.1186/s12882-020-02156-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/12/2020] [Accepted: 11/08/2020] [Indexed: 01/24/2023] Open
Abstract
Background Although young adulthood is associated with transplant loss, many studies do not examine eGFR decline. We aimed to establish clinical risk factors to identify where early intervention might prevent subsequent adverse transplant outcomes. Methods Retrospective cohort study using UK Renal Registry and UK Transplant Registry data, including patients aged < 30 years transplanted 1998–2014. Associations with death-censored graft failure were investigated with multivariable Cox proportional hazards. Multivariable linear regression was used to establish associations with eGFR slope gradients calculated over the last 5 years of observation per individual. Results The cohort (n = 5121, of whom n = 371 received another transplant) was 61% male, 80% White and 36% had structural disease. Live donation occurred in 48%. There were 1371 graft failures and 145 deaths with a functioning graft over a 39,541-year risk period. Median follow-up was 7 years. Fifteen-year graft survival was 60.2% (95% CI 58.1, 62.3). Risk associations observed in both graft loss and eGFR decline analyses included female sex, glomerular diseases, Black ethnicity and young adulthood (15–19-year and 20–24-year age groups, compared to 25–29 years). A higher initial eGFR was associated with less risk of graft loss but faster eGFR decline. For each additional 10 mL/min/1.73m2 initial eGFR, the hazard ratio for graft loss was 0.82 (95% CI 0.79, 0.86), p < 0.0001. However, compared to < 60 mL/min/1.73m2, higher initial eGFR was associated with faster eGFR decline (> 90 mL/min/1.73m2; − 3.55 mL/min/1.73m2/year (95% CI -4.37, − 2.72), p < 0.0001). Conclusions In conclusion, young adulthood is a key risk factor for transplant loss and eGFR decline for UK children and young adults. This study has an extended follow-up period and confirms common risk associations for graft loss and eGFR decline, including female sex, Black ethnicity and glomerular diseases. A higher initial eGFR was associated with less risk of graft loss but faster rate of eGFR decline. Identification of children at risk of faster rate of eGFR decline may enable early intervention to prolong graft survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02156-2.
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Affiliation(s)
- Alexander J Hamilton
- Population Health Sciences, University of Bristol, G.04, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Lucy A Plumb
- Population Health Sciences, University of Bristol, G.04, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,UK Renal Registry, Bristol, UK
| | | | - Manish D Sinha
- Evelina London Children's Hospital, London, UK.,Kings College London, London, UK
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Lalayiannis AD, Crabtree NJ, Ferro CJ, Askiti V, Mitsioni A, Biassoni L, Kaur A, Sinha MD, Wheeler DC, Duncan ND, Popoola J, Milford DV, Long J, Leonard MB, Fewtrell M, Shroff R. Routine serum biomarkers, but not dual-energy X-ray absorptiometry, correlate with cortical bone mineral density in children and young adults with chronic kidney disease. Nephrol Dial Transplant 2020; 36:1872-1881. [DOI: 10.1093/ndt/gfaa199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background. Biomarkers and dual-energy X-ray absorptiometry (DXA) are thought to be poor predictors of bone mineral density (BMD). The Kidney Disease: Improving Global Outcomes guidelines suggest using DXA if the results will affect patient management, but this has not been studied in children or young adults in whom bone mineral accretion continues to 30 years of age. We studied the clinical utility of DXA and serum biomarkers against tibial cortical BMD (CortBMD) measured by peripheral quantitative computed tomography, expressed as Z-score CortBMD, which predicts fracture risk.
Methods. This was a cross-sectional multicentre study in 26 patients with CKD4 and 5 and 77 on dialysis.
Results. Significant bone pain that hindered activities of daily living was present in 58%, and 10% had at least one low-trauma fracture. CortBMD and cortical mineral content Z-scores were lower in dialysis compared with CKD patients (P = 0.004 and P = 0.02). DXA BMD hip and lumbar spine Z-scores did not correlate with CortBMD or biomarkers. CortBMD was negatively associated with parathyroid hormone (PTH; r = −0.44, P < 0.0001) and alkaline phosphatase (ALP; r = −0.22, P = 0.03) and positively with calcium (Ca; r = 0.33, P = 0.001). At PTH <3 times upper limit of normal, none of the patients had a CortBMD below −2 SD (odds ratio 95% confidence interval 7.331 to infinity). On multivariable linear regression PTH (β = −0.43 , P < 0.0001), ALP (β = −0.36, P < 0.0001) and Ca (β = 0.21, P = 0.005) together predicted 57% of variability in CortBMD. DXA measures did not improve this model.
Conclusions. Taken together, routinely used biomarkers, PTH, ALP and Ca, but not DXA, are moderate predictors of cortical BMD. DXA is not clinically useful and should not be routinely performed in children and young adults with CKD 4–5D.
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Affiliation(s)
- Alexander D Lalayiannis
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
| | - Nicola J Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Charles J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Lorenzo Biassoni
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, 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
| | - 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
| | - Joyce Popoola
- Department of Nephrology and Transplantation, George’s University Hospital NHS Foundation Trust, London, UK
| | - David V Milford
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Jin Long
- Stanford University, Palo Alto, CA, USA
| | | | - Mary Fewtrell
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
| | - Rukshana Shroff
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
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Abstract
PURPOSE OF REVIEW To review the haemodynamic characteristics of paediatric hypertension. RECENT FINDINGS Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children.
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Affiliation(s)
- Ye Li
- King's College London British Heart Foundation Centre, London, UK
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Emily Haseler
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, UK.
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, UK
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
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48
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Joyce T, Rasmussen P, Melhem N, Clothier J, Booth C, Sinha MD. Vitamin and trace element concentrations in infants and children with chronic kidney disease. Pediatr Nephrol 2020; 35:1463-1470. [PMID: 32291535 PMCID: PMC7316696 DOI: 10.1007/s00467-020-04536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3-5 of chronic kidney disease (CKD). METHODS Retrospective cross-sectional review for nutritional blood concentrations measured over a recent 2-year period. In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B12 and folate are monitored annually. Vitamin D status is monitored every 6-12 months. RESULTS We reviewed 112 children (70 boys) with median (IQ1, IQ3) age 8.97 (4.24, 13.80) years. Estimated median (IQ1, IQ3) GFR (mL/min/1.73 m2) was 28 (21, 37). Vitamin A, active vitamin B12 and vitamin E concentrations were within normal range in 19%, 23% and 67% respectively, with all others being above normal range. Vitamin D blood concentrations were within desired range for 85% (15% had low levels) and folate blood concentrations were within normal range in 92%, with the remainder above or below target. For trace elements, 60%, 85% and 87% achieved normal ranges for zinc, selenium and copper respectively. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges. CONCLUSIONS Several vitamin and trace element blood concentrations were outside normal reference ranges. Monitoring vitamin D and zinc blood concentrations is indicated due to the percentages with low levels in this group. Targeted vitamin and trace element supplementation should be considered where indicated rather than commencing multivitamin and/or mineral supplementation. Graphical abstract Vitamin and trace element concentrations in infants and children with non-dialysis chronic kidney disease.
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Affiliation(s)
- Triona Joyce
- Department of Nutrition and Dietetics, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Pernille Rasmussen
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joanna Clothier
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Caroline Booth
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK.
- Kings College London, London, UK.
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49
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Christakoudi S, Runglall M, Mobillo P, Rebollo-Mesa I, Tsui TL, Nova-Lamperti E, Taube C, Norris S, Kamra Y, Hilton R, Augustine T, Bhandari S, Baker R, Berglund D, Carr S, Game D, Griffin S, Kalra PA, Lewis R, Mark PB, Marks SD, MacPhee I, McKane W, Mohaupt MG, Paz-Artal E, Kon SP, Serón D, Sinha MD, Tucker B, Viklický O, Stahl D, Lechler RI, Lord GM, Hernandez-Fuentes MP. Development and validation of the first consensus gene-expression signature of operational tolerance in kidney transplantation, incorporating adjustment for immunosuppressive drug therapy. EBioMedicine 2020; 58:102899. [PMID: 32707447 PMCID: PMC7374249 DOI: 10.1016/j.ebiom.2020.102899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/16/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Kidney transplant recipients (KTRs) with “operational tolerance” (OT) maintain a functioning graft without immunosuppressive (IS) drugs, thus avoiding treatment complications. Nevertheless, IS drugs can influence gene-expression signatures aiming to identify OT among treated KTRs. Methods We compared five published signatures of OT in peripheral blood samples from 18 tolerant, 183 stable, and 34 chronic rejector KTRs, using gene-expression levels with and without adjustment for IS drugs and regularised logistic regression. Findings IS drugs explained up to 50% of the variability in gene-expression and 20–30% of the variability in the probability of OT predicted by signatures without drug adjustment. We present a parsimonious consensus gene-set to identify OT, derived from joint analysis of IS-drug-adjusted expression of five published signature gene-sets. This signature, including CD40, CTLA4, HSD11B1, IGKV4–1, MZB1, NR3C2, and RAB40C genes, showed an area under the curve 0⋅92 (95% confidence interval 0⋅88–0⋅94) in cross-validation and 0⋅97 (0⋅93–1⋅00) in six months follow-up samples. Interpretation We advocate including adjustment for IS drug therapy in the development stage of gene-expression signatures of OT to reduce the risk of capturing features of treatment, which could be lost following IS drug minimisation or withdrawal. Our signature, however, would require further validation in an independent dataset and a biomarker-led trial. Funding FP7-HEALTH-2012-INNOVATION-1 [305147:BIO-DrIM] (SC,IR-M,PM,DSt); MRC [G0801537/ID:88245] (MPH-F); MRC [MR/J006742/1] (IR-M); Guy's&StThomas’ Charity [R080530]&[R090782]; CONICYT-Bicentennial-Becas-Chile (EN-L); EU:FP7/2007–2013 [HEALTH-F5–2010–260687: The ONE Study] (MPH-F); Czech Ministry of Health [NV19–06–00031] (OV); NIHR-BRC Guy's&StThomas' NHS Foundation Trust and KCL (SC); UK Clinical Research Networks [portfolio:7521].
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Affiliation(s)
- Sofia Christakoudi
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Manohursingh Runglall
- NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Paula Mobillo
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Irene Rebollo-Mesa
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Tjir-Li Tsui
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | | | - Catharine Taube
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Sonia Norris
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Yogesh Kamra
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Rachel Hilton
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Titus Augustine
- Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK
| | - Sunil Bhandari
- Hull University Teaching Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, UK
| | - Richard Baker
- St James's University Hospital, Beckett St, Leeds LS9 7TF, UK
| | - David Berglund
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbecklaboratoriet, 751 85 Uppsala, Sweden
| | - Sue Carr
- Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW, UK
| | - David Game
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Sian Griffin
- Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Philip A Kalra
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Robert Lewis
- Queen Alexandra Hospital, Southwick Hill Rd, Cosham, Portsmouth PO6 3LY, UK
| | - Patrick B Mark
- University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, UK
| | - Iain MacPhee
- St George's Hospital, Blackshaw Rd, London SW17 0QT, UK & Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London SW17 0RE
| | - William McKane
- Northern General Hospital, Herries Rd, Sheffield S5 7AU, UK
| | - Markus G Mohaupt
- Internal Medicine, Lindenhofgruppe Berne, Switzerland; University of Bern, Berne, Switzerland; School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Estela Paz-Artal
- Department of Immunology and imas12 Research Institute, University Hospital 12 de Octubre, Madrid, Spain
| | - Sui Phin Kon
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Daniel Serón
- Hospital Universitario Vall d'Hebrón, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manish D Sinha
- Evelina London Children's Hospital, Westminster Bridge Rd, Lambeth, London SE1 7EH, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Beatriz Tucker
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Ondrej Viklický
- Transplantační laboratoř, Institut klinické a experimentální medicíny (IKEM), Vídeňská 1958/9, 140 21 Praha 4, Czech Republic
| | - Daniel Stahl
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Robert I Lechler
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Graham M Lord
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Great Maze Pond, London SE1 9RT, UK; Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Maria P Hernandez-Fuentes
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, UK; King's Health Partners, Guy's Hospital, London SE1 9RT, UK
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50
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Abstract
Background Primary hypertension in children is often characterized by high pulse pressure that could be attributable to increased ventricular ejection velocities and volumes and/or increased arterial stiffness. The objective of this study was to examine the contributions of cardiac (ventricular ejection) and vascular (systemic vascular resistance, arterial stiffness, and pressure wave reflection) properties to primary hypertension in children and adolescents. Methods and Results Children aged 8 to 18 years referred to a tertiary center for evaluation of hypertension and found to have primary hypertension (n=31) were compared with normotensive controls of similar age (n=50). Peripheral (brachial) and central (carotid) blood pressure waveforms and carotid‐femoral pulse wave velocity were measured by tonometry. Left ventricular outflow tract velocities and ejection volumes were measured by echocardiography. Wave separation and wave intensity analysis were used to assess pressure wave propagation. Increased mean arterial pressure in hypertensive children (90±15 versus 76±10 mmHg in hypertensive versus normotensive children; means±SD; P<0.001) was explained by increased heart rate and cardiac output (5.3±2.0 versus 4.5±1.2 L/min adjusted for age and sex; P<0.05) rather than increased systemic vascular resistance (18.0±4.6 versus 19.3±7.3 mmHg/min/mL; P=0.374). A more‐marked increase in pulsatility (peripheral pulse pressure 66±21 versus 46±12 mmHg; P<0.001) was explained by increased proximal aortic stiffness (pulse wave velocity, 3.3±1.4 versus 2.5±0.8 m/s; P<0.005) and increased left ventricular ejection velocity (1.33±0.24 versus 1.21±0.18 m/s; P<0.05). Conclusions Cardiac overactivity characterized by increased heart rate and left ventricular ejection velocities and increased proximal pulse wave velocity may be the main cause of primary hypertension in children.
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Affiliation(s)
- Ye Li
- King's College London British Heart Foundation Centre London United Kingdom
| | - Haotian Gu
- King's College London British Heart Foundation Centre London United Kingdom
| | - Manish D Sinha
- King's College London British Heart Foundation Centre London United Kingdom.,Department of Pediatric Nephrology Evelina London Children's Hospital London United Kingdom
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre London United Kingdom
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