title: Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease.
abstract: OBJECTIVE
  Metabolic abnormalities and cardiovascular disease (CVD) risk factors have rarely been systematically assessed in children with chronic kidney disease (CKD). We examined the prevalence of various CKD sequelae across the GFR spectrum.
  
  
  METHODS
  Data were used from 586 children participating in the Chronic Kidney Disease in Children (CKiD) study (United States and Canada) with GFR measured by iohexol plasma disappearance. Laboratory values and CVD risk factors were compared across GFR categories and with an age-, gender-, and race-matched community sample.
  
  
  RESULTS
  CKiD participants were 62% male, 66% Caucasian, 23% African American, and 15% Hispanic with a median age of 11 years and a median GFR of 44 ml/min per 1.73 m(2). Compared with those with a GFR ≥ 50 ml/min per 1.73 m(2), having a GFR < 30 ml/min per 1.73 m(2) was associated with a three-fold higher risk of acidosis and growth failure and a four- to five-fold higher risk of anemia and elevated potassium and phosphate. Median GFR change was -4.3 ml/min per 1.73 m(2) and -1.5 ml/min per 1.73 m(2) per year in children with glomerular and nonglomerular diagnoses, respectively. Despite medication and access to nephrology care, uncontrolled systolic hypertension was present in 14%, and 16% had left ventricular hypertrophy. Children with CKD frequently were also shorter and had lower birth weight, on average, compared with norms.
  
  
  CONCLUSIONS
  Growth failure, metabolic abnormalities, and CVD risk factors are present at GFR >50 ml/min per 1.73 m(2) in children with CKD and, despite therapy, increase in prevalence two- to four-fold with decreasing GFR.
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. Furths@email.chop.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.forename: Judith
authors.initials: J
authors.lastname: Jerry-Fluker
authors.forename: George J
authors.initials: GJ
authors.lastname: Schwartz
authors.forename: Mark
authors.initials: M
authors.lastname: Benfield
authors.forename: Frederick
authors.initials: F
authors.lastname: Kaskel
authors.forename: Craig
authors.initials: C
authors.lastname: Wong
authors.forename: Robert H
authors.initials: RH
authors.lastname: Mak
authors.forename: Marva
authors.initials: M
authors.lastname: Moxey-Mims
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D002908:Chronic Disease; D004573:Electrolytes / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000150:complications* / Q000378:metabolism; D008297:Male; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL; D004573:Electrolytes