title: Assessment of the cardiovascular system in pediatric chronic kidney disease: a pilot study.
abstract: Long-term survival of children and adolescents with chronic kidney disease (CKD) is mainly limited by cardiovascular disease. Pediatric CKD patients (n = 26) on conservative treatment, dialysis and after renal transplantation were compared with healthy controls (n = 24) with respect to cardiovascular status. Mean baseline diameter of the brachial artery was significantly higher, and mean flow-mediated vasodilation (FMD) was significantly reduced, in CKD patients. CKD patients showed significantly increased left ventricular mass index, blood pressure (BP) values and age-related values of mean carotid intima-media thickness [intima-media thickness-standard deviation score (IMT-SDS)] compared with those of controls. Approximately 60% of patients presented with impaired FMD (< or = 5.79%), which was significantly associated with intima-media thickening, although only three patients (12%) presented with both, impaired FMD and increased age-related IMT. The latter was significantly associated with higher values for day-time BP. In contrast, duration and degree of CKD, mode of renal replacement therapy, homocysteine levels and concomitant medication showed no association with cardiovascular status. The majority of our pediatric CKD patients showed reduced endothelial function, which may have preceded the development of carotid arteriopathy. Therefore, routine assessment of FMD may be a useful tool to identify CKD patients at risk of progressive cardiovascular morbidity.
authors.affiliation: Department of Pediatrics, University of Rostock, Rostock, Germany. jutta.muscheites@uni-rostock.de
authors.forename: Jutta
authors.initials: J
authors.lastname: Muscheites
authors.forename: Andreas Alexander
authors.initials: AA
authors.lastname: Meyer
authors.forename: Erdmute
authors.initials: E
authors.lastname: Drueckler
authors.forename: Marianne
authors.initials: M
authors.lastname: Wigger
authors.forename: Dagmar-Christiane
authors.initials: DC
authors.lastname: Fischer
authors.forename: Guenther
authors.initials: G
authors.lastname: Kundt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kienast
authors.forename: Dieter
authors.initials: D
authors.lastname: Haffner
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000503:physiopathology; D002319:Cardiovascular System / Q000473:pathology* / Q000503:physiopathology*; D002339:Carotid Arteries / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007674:Kidney Diseases / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D010865:Pilot Projects; D012039:Regional Blood Flow / Q000502:physiology; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D055815:Young Adult