title: Carotid intima-media thickness in children with CKD: results from the CKiD study.
abstract: OBJECTIVE
  In adults, increased carotid intima-media thickness (cIMT) as assessed by ultrasonography is a valid predictor of cardiovascular events. Children with CKD are known to be at increased cardiovascular risk. This study sought to identify cardiovascular risk factors associated with increased cIMT in children with CKD.
  
  
  METHODS
  This was a cross-sectional analysis of cIMT obtained after 12 months of follow-up of 101 children aged 2-18 years with mild to moderate CKD (median GFR 42.9 ml/min per 1.73 m(2)) in the Chronic Kidney Disease in Children cohort study enrolled between April 2005 and September 2009 and 97 healthy pediatric controls between January 2003 and December 2008. An average of six standardized B-mode ultrasound measurements constituted the overall cIMT measurement.
  
  
  RESULTS
  The median cIMT was 0.43 mm (interquartile range, 0.38-0.48) compared with 0.41 mm in healthy controls (P=0.03 for difference). After multivariable adjustment, the median cIMT was 0.02 mm (95% confidence interval [CI], 0.01-0.05) larger than that of the healthy controls. In a multivariable linear regression analysis, dyslipidemia and hypertension were associated with 0.05 mm (95% CI, 0.01-0.08) and 0.04 mm (95% CI, 0.003-0.08) greater mean cIMT, respectively. Body mass index, CKD etiology, GFR, birth weight, pubertal status, calcium, phosphorus, sex, and race were not associated with cIMT.
  
  
  CONCLUSIONS
  cIMT is significantly elevated among children with CKD, as is the prevalence of other cardiovascular risk factors. Of these risk factors, hypertension and dyslipidemia are significantly associated with increased cIMT.
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD 21287, USA. tbrady8@jhmi.edu
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Brady
authors.forename: Michael F
authors.initials: MF
authors.lastname: Schneider
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Flynn
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Joshua
authors.initials: J
authors.lastname: Samuels
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Saland
authors.forename: Colin T
authors.initials: CT
authors.lastname: White
authors.forename: Susan
authors.initials: S
authors.lastname: Furth
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Mark
authors.initials: M
authors.lastname: Mitsnefes
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D015992:Body Mass Index; D059168:Carotid Intima-Media Thickness; D002648:Child; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D015228:Hypertriglyceridemia / Q000150:complications / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012307:Risk Factors