Abnormal carotid artery structure and function in children and adolescents with successful renal transplantation.
BACKGROUND
Abnormal carotid artery compliance and increased intima-media thickness (IMT), markers of early atherosclerosis, are prevalent in adults with chronic kidney failure. However, little is known about the extent of these abnormalities in children after transplantation.


RESULTS
Thirty-one children (age, 14.5+/-4.1 years) with renal transplant (estimated glomerular filtration rate, 78.1+/-24.5 mL/min per 1.73 m2; range, 44 to 128 mL/min per 1.73 m2) and 33 age- and sex-matched control subjects had ultrasound of the carotid artery, echocardiography, and ambulatory blood pressure monitoring (transplant patients only). IMT was measured, and distensibility and stiffness parameter (beta) were calculated to assess carotid artery structure and function. The results were correlated with demographic, clinical, and biochemical variables. Compared with control subjects, children with transplant had higher IMT (P=0.03) and beta (P<0.0001) and lower distensibility (P<0.001). In multiple regression analysis, increased IMT in children who had received transplants was associated with higher mean office systolic blood pressure taken within 1 year before the study (R2=0.19, P=0.024) and receipt of >1 transplant (R2=0.16, P=0.02). Worse distensibility and beta were significantly associated with higher daytime systolic blood pressure load calculated from ambulatory blood pressure and receipt of cadaveric kidney. When number of antihypertensives was added to the models, only higher number of blood pressure medications independently predicted abnormal distensibility (R2=0.38, P=0.002) and beta (R2=0.25, P=0.016).


CONCLUSIONS
Carotid arteriopathy is present in children with successful renal transplant and is associated with hypertension. The results suggest that these children might be at risk for accelerated atherosclerosis and premature cardiovascular disease.
Mitsnefes
Mark M
MM
Division of Nephrology and Hypertension, Cincinnati Children's Hospital, MLC 7022, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039, USA. mark.mitsnefes@cchmc.org
Kimball
Thomas R
TR
Witt
Sandra A
SA
Glascock
Betty J
BJ
Khoury
Philip R
PR
Daniels
Stephen R
SR
D000293:Adolescent; D000328:Adult; D001161:Arteriosclerosis / Q000473:pathology* / Q000503:physiopathology*; D001794:Blood Pressure; D002339:Carotid Arteries / Q000473:pathology* / Q000503:physiopathology*; D002648:Child; D003187:Compliance; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male