title: Traditional and "new" cardiovascular risk markers and factors in pediatric dialysis patients.
abstract: Cardiovascular disease (CVD) is the principal cause of mortality in patients with end-stage renal disease (ESRD). The aim of this study was to analyze carotid intima-media thickness (cIMT), endothelium-dependent dilatation (EDD), and left ventricular mass index (LVMI) as the cardiovascular risk markers and to investigate the independent risk factors of these markers in pediatric dialysis patients. This study included 39 children and adolescents undergoing dialysis (15 hemodialysis and 24 peritoneal dialysis) and 15 age- and gender-matched healthy subjects. The cIMT and EDD were assessed by high-resolution ultrasound, and LVMI was calculated from standard echocardiographic measurements. Compared with control subjects, cIMT standard deviation scores (SDS), LVMI, total homocysteine (tHcy), and high-sensitivity C-reactive protein (hs-CRP) values were significantly higher in patients, but EDD values did not differ. The mean hs-CRP level was significantly higher in hemodialysis (HD) patients than in peritoneal dialysis (PD) patients. The cIMT-SDS and LVMI were associated with several variables in univariate analysis. Stepwise linear regression analysis, indexed SBP (p = 0.017), and hemoglobin (p = 0.001) turned out to be independent variables for predicting LVMI, and a significant predictor of cIMT was indexed diastolic blood pressure (DBP) (p = 0.035). The causes of atherosclerosis and left ventricular hypertrophy are multifactorial in children and adolescents with ESRD. Better management of hypertension and anemia may be priorities for preventing or improving CVD in these patients.
authors.affiliation: Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, 34303 Cerrahpasa, Istanbul, Turkey. drcivilibal@hotmail.com
authors.forename: Mahmut
authors.initials: M
authors.lastname: Civilibal
authors.forename: Salim
authors.initials: S
authors.lastname: Caliskan
authors.forename: Huseyin
authors.initials: H
authors.lastname: Oflaz
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
authors.forename: Cengiz
authors.initials: C
authors.lastname: Candan
authors.forename: Nur
authors.initials: N
authors.lastname: Canpolat
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kasapcopur
authors.forename: Zehra
authors.initials: Z
authors.lastname: Bugra
authors.forename: Nil
authors.initials: N
authors.lastname: Arisoy
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D002319:Cardiovascular System / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D004452:Echocardiography; D005260:Female; D006711:Homocystine / Q000097:blood; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology; D008297:Male; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000145:classification* / Q000706:statistics & numerical data; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D015415:Biomarkers; D006711:Homocystine; D002097:C-Reactive Protein