Cardiovascular risk assessment in children with chronic kidney disease.
Chronic kidney disease (CKD) is a major factor contributing to cardiovascular (CV) morbidity and mortality with the highest risk in patients on dialysis. An estimation of CV risk is important not only to identify potential modifiable risk factors but also to evaluate the effect of treatments aimed to reduce the risk. Non-invasive methods of measuring vascular changes and circulating biomarkers are available to assess the presence and severity of cardiovascular damage. These include measures of structural (carotid intima-media thickness and coronary artery calcification score) and functional (aortic pulse wave velocity, 24-h ambulatory blood pressure monitoring, ambulatory arterial stiffness index, heart rate variability and flow-mediated dilatation) changes in the vessel wall. In addition, a number of circulating biomarkers of vascular damage and its progression have been studied. Many of these tests are well validated as surrogate markers of future cardiovascular events and death in adult CKD patients, but need technical adaptation, standardization and validation for use in children. With our current state of knowledge, these are best reserved for research studies and scarce clinical resources may be better utilized for preventative strategies to reduce the modifiable risk factors for calcification from early CKD stages.
Renal Unit, Great Ormond Street Hospital for Children, London, UK.
Rukshana
R
Shroff
Arianna
A
Dégi
Andrea
A
Kerti
Eva
E
Kis
Orsolya
O
Cseprekál
Kálmán
K
Tory
Attila J
AJ
Szabó
George S
GS
Reusz
D000293:Adolescent; D018660:Blood Pressure Monitoring, Ambulatory; D002135:Calcium-Binding Proteins / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D002648:Child; D004548:Elasticity; D016326:Extracellular Matrix Proteins / Q000502:physiology; D006339:Heart Rate; D006801:Humans; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D018570:Risk Assessment; D061205:Vascular Calcification / Q000209:etiology; D059289:Vascular Stiffness; D014664:Vasodilation; D000097568:Matrix Gla Protein
D002135:Calcium-Binding Proteins; D016326:Extracellular Matrix Proteins; D000097568:Matrix Gla Protein