title: When does the cardiovascular disease appear in patients with chronic kidney disease?
abstract: Cardiovascular disease is a leading cause of long-term morbidity and mortality among children with chronic kidney disease (CKD). At which stage of CKD these appear in children is unknown. This study aimed to determine the prevalence of cardiovascular disease in pediatric CKD patients and to explore the relationship of these changes and treatment methods. The study enrolled pediatric patients with stages 1-5 CKD including 20 patients receiving predialysis (PreD), 8 receiving peritoneal dialysis, and 14 receiving hemodialysis. Aortic stiffness, defined as decreased aortic strain (S) and increased pressure strain normalized by diastolic pressure (Ep*), was described. Sonography of the common carotid artery and left ventricle was performed. The mean age of the children was 13.3 + or - 5.3 years. The patients had lower S values (0.35 + or - 0.23) than the control subjects (0.44 + or - 0.2) (P < 0.05) but higher Ep* (2.46 + or - 1.31 vs. 1.32 + or - 0.09; P < 0.05). Aortic stiffness was found in 13 patients. The PreD group had lower As levels than the dialysis group but higher levels than the control group. The patients (n = 32) had greater carotid intima-media thickness than the control subjects (0.58 + or - 0.14 vs. 0.35 + or - 0.12; P < 0.05). The intima-media thickness was greatest in the PreD group (P < 0.05). The patients had a higher left ventricular mass index (LVMI; 42.4 + or - 15.6) than the control subjects (28.8 + or - 8.47) (P < 0.05) and a larger left ventricle end diastolic diameter (LVEDD; 3.44 + or - 0.76 vs. 2.59 + or - 0.34; P < 0.05). Left ventricular hypertrophy was found in 32 patients. Both LVMI and LVEDD were higher in the groups receiving hemodialysis and lower in the PreD group. Increased carotid-intima media thickness and left ventricle hypertrophy appeared without hypertension in the PreD group. The indications and timing of dialysis should be reevaluated for children with CKD. In the dialysis groups, fewer cardiovascular changes were found with peritoneal dialysis than with hemodialysis. Therefore, peritoneal dialysis should be preferable to hemodialysis for children with CKD.
authors.affiliation: Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey. betulsozeri@yahoo.com
authors.forename: Betul
authors.initials: B
authors.lastname: Sozeri
authors.forename: Sevgi
authors.initials: S
authors.lastname: Mir
authors.forename: Orhan Deniz
authors.initials: OD
authors.lastname: Kara
authors.forename: Erturk
authors.initials: E
authors.lastname: Levent
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology; D008297:Male; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014421:Turkey / Q000453:epidemiology; D014463:Ultrasonography; D055815:Young Adult
references.citation: Pediatr Nephrol. 2005 Mar;20(3):374-9
references.pmid: 15549413
references.citation: Int J Pediatr Nephrol. 1982 Dec;3(4):311-4
references.pmid: 7166455
references.citation: Nat Rev Nephrol. 2009 May;5(5):287-96
references.pmid: 19384330
references.citation: Perit Dial Int. 2005 Feb;25 Suppl 3:S120-2
references.pmid: 16048275
references.citation: Pediatr Nephrol. 2005 Jan;20(1):64-8
references.pmid: 15517416
references.citation: Pediatr Nephrol. 2009 Apr;24(4):707-19
references.pmid: 18784945
references.citation: J Adolesc Health. 2004 Apr;34(4):339-43
references.pmid: 15041004
references.citation: Pediatr Nephrol. 2008 Jan;23(1):27-39
references.pmid: 17120060
references.citation: Circulation. 1977 Apr;55(4):613-8
references.pmid: 138494
references.citation: J Am Soc Nephrol. 2004 May;15(5):1307-15
references.pmid: 15100371
references.citation: Pediatr Cardiol. 2001 May-Jun;22(3):198-203
references.pmid: 11343141
references.citation: Nephrol Dial Transplant. 2000 Jul;15(7):1014-21
references.pmid: 10862640
references.citation: Am J Kidney Dis. 2005 Mar;45(3):494-501
references.pmid: 15754271
references.citation: Am J Hypertens. 2002 May;15(5):405-9
references.pmid: 12022242
references.citation: Am J Kidney Dis. 1999 Jul;34(1):125-34
references.pmid: 10401026
references.citation: J Am Coll Cardiol. 1992 Nov 1;20(5):1251-60
references.pmid: 1401629
references.citation: Circulation. 2002 Jul 2;106(1):100-5
references.pmid: 12093777
references.citation: J Am Soc Nephrol. 2005 Sep;16(9):2796-803
references.pmid: 16049067
references.citation: J Pediatr Endocrinol Metab. 2002 Apr;15(4):405-9
references.pmid: 12008687
references.citation: J Pediatr Endocrinol Metab. 2000;13 Suppl 6:1395-402
references.pmid: 11202215
references.citation: Circulation. 2003 Feb 18;107(6):864-8
references.pmid: 12591757
references.citation: Kidney Int. 1995 Jan;47(1):186-92
references.pmid: 7731145
references.citation: Am J Kidney Dis. 2005 Jun;45(6):965-77
references.pmid: 15957125
references.citation: Eur Heart J. 2005 Jun;26(12):1213-20
references.pmid: 15824075
references.citation: Pediatr Nephrol. 2006 Aug;21(8):1171-8
references.pmid: 16850307
references.citation: N Engl J Med. 1999 Jan 14;340(2):115-26
references.pmid: 9887164
references.citation: Hypertension. 1998 Sep;32(3):570-4
references.pmid: 9740628
references.citation: Am J Kidney Dis. 1994 Nov;24(5):768-76
references.pmid: 7977318
references.citation: Pediatr Nephrol. 2007 Nov;22(11):1911-9
references.pmid: 17710441
references.citation: Am Heart J. 1985 Jul;110(1 Pt 1):102-6
references.pmid: 3160226
references.citation: Eur Heart J. 1992 Aug;13(8):1040-5
references.pmid: 1505552
references.citation: Hypertension. 2009 Nov;54(5):919-50
references.pmid: 19729599
references.citation: J Pediatr. 2006 Nov;149(5):671-5
references.pmid: 17095341
references.citation: Am J Kidney Dis. 2000 Oct;36(4):811-9
references.pmid: 11007685
references.citation: JAMA. 2001 Dec 12;286(22):2845-8
references.pmid: 11735760
references.citation: Adv Chronic Kidney Dis. 2004 Jul;11(3):319-27
references.pmid: 15241746
references.citation: J Am Soc Nephrol. 2005 May;16(5):1494-500
references.pmid: 15772249
references.citation: Nephrol Dial Transplant. 2006 Mar;21(3):729-35
references.pmid: 16221688
references.citation: Contrib Nephrol. 1986;52:86-96
references.pmid: 3568672
references.citation: Kidney Int. 1996 Sep;50(3):998-1006
references.pmid: 8872976
references.citation: Pediatr Nephrol. 2001 Apr;16(4):318-23
references.pmid: 11354774
references.citation: J Am Soc Nephrol. 2006 Jan;17(1):218-26
references.pmid: 16280471
references.citation: Nephrol Dial Transplant. 2008 Aug;23(8):2552-7
references.pmid: 18344239