title: Increased arterial stiffness in young adults with end-stage renal disease since childhood.
abstract: Increased arterial stiffness is a risk factor for mortality in adults over 40 yr of age with end-stage renal disease (ESRD). As no data exist on vascular changes in young adults with ESRD since childhood, a long-term outcome study was performed. All living Dutch adult patients with onset of ESRD between 1972 and 1992 at age 0 to 14 yr were invited for carotid artery and cardiac ultrasound and BP measurements. Data on clinical characteristics were collected by review of all medical charts. Carotid ultrasound data were compared with those of 48 age-matched and gender-matched healthy controls. Carotid artery and cardiac ultrasound was performed in 130 out of 187 eligible patients. Mean age was 29.0 (20.7 to 40.6) yr. Compared with controls, patients had a similar intima media thickness but a reduced mean arterial wall distensibility DC (40.0 versus 45.0 kPa(-1). 10(-3); 95% CI, -9.1 to -0.8; P < 0.001), an increased stiffness parameter beta (4.2 versus 3.8; 95% CI, 0.05 to 0.68; P = 0.02), an increased elastic incremental modulus E(inc) (0.35 versus 0.27 kPa. 10(3); 95% CI, 0.02 to 0.12; P < 0.001). Multiple regression analyses in all subjects revealed that ESRD was associated with an increase in beta and E(inc). Arterial wall properties of patients currently on dialysis and transplanted patients were comparable. In all patients, current systolic hypertension was associated with increased E(inc) and decreased DC. In conclusion, carotid arterial wall stiffness is increased in young adult patients with pediatric ESRD. Hypertension is a main determinant and might be a target for treatment of these potentially lethal arterial wall changes.
authors.affiliation: Department of Pediatric Nephrology, Emma Children's Hospital AMC, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, the Netherlands. j.w.groothoff@amc.uva.nl
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: Mariken P
authors.initials: MP
authors.lastname: Gruppen
authors.forename: Martin
authors.initials: M
authors.lastname: Offringa
authors.forename: Eric
authors.initials: E
authors.lastname: de Groot
authors.forename: Willem
authors.initials: W
authors.lastname: Stok
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: Bos
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Davin
authors.forename: Marc R
authors.initials: MR
authors.lastname: Lilien
authors.forename: Nicole Caj
authors.initials: NC
authors.lastname: Van de Kar
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wolff
authors.forename: Hugo S
authors.initials: HS
authors.lastname: Heymans
mesh_terms: D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015331:Cohort Studies; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008499:Medical Records; D012016:Reference Values; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology