title: Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report.
abstract: METHODS
  We aimed to clarify arteriosclerotic risk and to document possible relationships between cardiovascular risk factors and echocardiographic parameters in paediatric peritoneal dialysis (PD) patients. M-mode/Doppler/tissue Doppler echocardiographic studies and lipid/lipoproteins, homocysteine, high-sensitivity C-reactive protein (HS-CRP) levels and carotid intima-media thickness (CIMT) were determined in 59 patients (age: 14.2 +/- 4.5 years) and in 36 healthy subjects.
  
  
  RESULTS
  Structural and functional cardiac abnormalities were observed in patients on maintenance dialysis. Increased left ventricular mass index (LVMI, P = 0.000), relative wall thickness (P = 0.000), myocardial performance index (MPI, P = 0.000) were documented in the patients. Lipoprotein (a) (P = 0.000), homocysteine (P = 0.001), HS-CRP (P = 0.000) and CIMT (P = 0.000) were significantly elevated in the patients. Left ventricular hypertrophy (LVH) was prevalent in 68% of the patients. Patients with LVH had higher levels of HS-CRP (P = 0.001) and CIMT (P = 0.028) than those without LVH. Haemoglobin was an independent predictor of LVMI (beta: -8.9, P = 0.001), while residual diuresis and CIMT were independent predictors of diastolic dysfunction (beta: -0.45, P = 0.034 and beta: 5.90, P = 0.008, respectively). Albumin (beta: -0.72, P = 0.018) and Kt/V urea (beta: -0.48, P = 0.012) were significant predictors of CIMT. There were positive correlations between LVMI and CIMT. HS-CRP was positively correlated with LVMI as well as CIMT.
  
  
  CONCLUSIONS
  Elevated levels of atherosclerotic/ inflammatory risk factors, low haemoglobin levels and loss of residual renal function and their negative effects on heart are of remarkable importance in paediatric patients on maintenance peritoneal dialysis. Achieving recommended targets for haemoglobin, blood pressure and Kt/V urea, preserving residual renal function as well as managing inflammation and subsequent arteriosclerosis is obviously essential to improve the patients' prognosis.
authors.affiliation: Department of Pediatric Nephrology, Gazi University, Ankara, Turkey. sevcan@gazi.edu.tr
authors.forename: Sevcan A
authors.initials: SA
authors.lastname: Bakkaloglu
authors.forename: Arda
authors.initials: A
authors.lastname: Saygili
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
authors.forename: Aytul
authors.initials: A
authors.lastname: Noyan
authors.forename: Sema
authors.initials: S
authors.lastname: Akman
authors.forename: Mesiha
authors.initials: M
authors.lastname: Ekim
authors.forename: Nejat
authors.initials: N
authors.lastname: Aksu
authors.forename: Beyza
authors.initials: B
authors.lastname: Doganay
authors.forename: Nurdan
authors.initials: N
authors.lastname: Yildiz
authors.forename: Ali
authors.initials: A
authors.lastname: Duzova
authors.forename: Alper
authors.initials: A
authors.lastname: Soylu
authors.forename: Harika
authors.initials: H
authors.lastname: Alpay
authors.forename: Ferah
authors.initials: F
authors.lastname: Sonmez
authors.forename: Mahmut
authors.initials: M
authors.lastname: Civilibal
authors.forename: Sevcan
authors.initials: S
authors.lastname: Erdem
authors.forename: Firat
authors.initials: F
authors.lastname: Kardelen
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D002339:Carotid Arteries / Q000473:pathology; D002648:Child; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D009206:Myocardium / Q000473:pathology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein