Vascular Stiffness in Children With Chronic Kidney Disease
Jonathan D. Savant,Aisha Betoko,Keven E.C. Meyers,Mark Mitsnefes,Joseph T. Flynn,Raymond R. Townsend,Laurence Greenbaum,Allison Dart,Bradley A. Warady,Susan L. Furth +9 more
TLDR
Carotid-femoral pulse wave velocity increased significantly with age, mean arterial pressure, and black race in multivariable analysis; no other variables, including glomerular filtration rate, were independently associated with cfPWV.Abstract:
Carotid-femoral pulse wave velocity (cfPWV) is a measure of arterial stiffness associated with cardiovascular events in the general population and in adults with chronic kidney disease. However, few data exist regarding cfPWV in children with chronic kidney disease. We compared observed cfPWV assessed via applanation tonometry in children enrolled in the CKiD cohort study (Chronic Kidney Disease in Children) to normative data in healthy children and examined risk factors associated with elevated cfPWV. cfPWV Z score for height/gender and age/gender was calculated from and compared with published pediatric norms. Multivariable linear regression was used to assess the relationship between cfPWV and age, gender, race, body mass index, diagnosis, urine protein–creatinine ratio, mean arterial pressure, heart rate, number of antihypertensive medications, uric acid, and serum low-density lipoprotein. Of the 95 participants with measured cfPWV, 60% were male, 19% were black, 46% had glomerular cause of chronic kidney disease, 22% had urine protein–creatinine ratio 0.5 to 2.0 mg/mg and 9% had >2.0 mg/mg, mean age was 15.1 years, average mean arterial pressure was 80 mm Hg, and median glomerular filtration rate was 63 mL/min per 1.73 m 2 . Mean cfPWV was 5.0 m/s (SD, 0.8 m/s); mean cfPWV Z score by height/gender norms was −0.1 (SD, 1.1). cfPWV increased significantly with age, mean arterial pressure, and black race in multivariable analysis; no other variables, including glomerular filtration rate, were independently associated with cfPWV. In this pediatric cohort with mild kidney dysfunction, arterial stiffness was comparable to that of normal children. Future research is needed to examine the impact of chronic kidney disease progression on arterial stiffness and associated cardiovascular parameters in children.read more
Citations
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Maternal Exposure to Ambient Particulate Matter ≤2.5 µm During Pregnancy and the Risk for High Blood Pressure in Childhood.
Mingyu Zhang,Noel T. Mueller,Hongjian Wang,Hongjian Wang,Xiumei Hong,Lawrence J. Appel,Xiaobin Wang +6 more
TL;DR: It is suggested that exposure to ambient PM2.5 during the third trimester of pregnancy is associated with elevated BP in children, ages 3 to 9 years.
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Cardiovascular Disease in Children and Adolescents With Chronic Kidney Disease.
Donald J. Weaver,Mark Mitsnefes +1 more
TL;DR: The prevalence of the risk factors associated with cardiovascular disease in pediatric patients with CKD, the pathophysiology that stimulates these changes, the cardiac and vascular adaptations that occur in these patients, and management of the cardiovascular risk are discussed.
Journal ArticleDOI
Cardiovascular Disease Risk in Children With Kidney Disease.
TL;DR: Early identification of modifiable risk factors and treatment may lead to a decrease of long-term cardiovascular morbidity and mortality, but evidence in this population is lacking.
Journal ArticleDOI
Role of hypertension in progression of chronic kidney disease in children.
TL;DR: Early diagnosis of hypertension by ABPM and identification of subclinical cardiovascular changes provide a window for intervention, which may reverse early cardiovascular disease, thereby delaying dialysis and improving cardiovascular morbidity and mortality.
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Pathophysiology and consequences of arterial stiffness in children with chronic kidney disease.
TL;DR: Mechanisms leading to arterial stiffness in CKD and its clinical implications, along with issues surrounding the technical aspects of arterial stiffening assessment in children are discussed.
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