Increased arterial stiffness in children on haemodialysis.
BACKGROUND
Measures of aortic stiffness--aortic pulse wave velocity (PWV) and augmentation index (AIx)--have been shown to be powerful predictors of survival in adult haemodialysis (HD) patients. Very few data have been reported regarding arterial stiffness in paediatric renal populations.


METHODS
PWV and aortic AIx were determined from contour analysis of arterial waveforms recorded by applanation tonometry using a SphygmoCor device in 14 children on HD (age = 14.1 years) and in 15 age, height matched children controls.


RESULTS
Pre-HD AIx (29.7 +/- 15.4%) and PWV (6.6 +/- 1.0 m/s) were significantly higher compared with children controls (8.3 +/- 8.0% and 5.4 +/- 0.6 m/s, respectively, P < 0.0001). The only significant difference between normal and HD children was BP level: 103/61 vs 114/72 mmHg, P < 0.05. In children of HD patients, a multiple linear regression model including BP, age, height, weight, Ca and P levels as independent variables accounted for 57% of the variability in AIx. Dialysis had no impact on AIx (post-HD: 28.5 +/- 12.7%) or on PWV (post-HD: 6.7 +/- 0.8 m/s).


CONCLUSIONS
We show, in this first-ever report of increased arterial stiffness in children on dialysis, that end-stage renal disease is associated with abnormalities in arterial wall elastic properties, comparable with adult levels, even in childhood. Most importantly, the absence of a discernible amelioration with dialysis implies that purely structural and not functional alterations lie behind the increased arterial stiffness.
Covic
Adrian
A
Dialysis and Transplantation Center, C. I. Parhon University Hospital, Iaşi, Romania. acovic@xnet.ro
Mardare
Nicoleta
N
Gusbeth-Tatomir
Paul
P
Brumaru
Ovidiu
O
Gavrilovici
Cristina
C
Munteanu
Mihaela
M
Prisada
Octavian
O
Goldsmith
David J A
DJ
D000293:Adolescent; D001013:Aorta, Thoracic / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis; D012720:Severity of Illness Index; D017539:Tunica Intima / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014655:Vascular Resistance / Q000502:physiology*