title: Cardiovascular alterations do exist in children with stage-2 chronic kidney disease.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is an important complication of chronic kidney disease (CKD) in children. However, it is not well known when and how cardiovascular alterations start.
  
  
  METHODS
  This cross-sectional, controlled study consisted of 25 patients and 28 healthy controls. 24-h ambulatory blood pressure monitoring, aortic pulse wave velocity (aPWV), carotid intima-media thickness (cIMT) and carotid distensibility (distensibility coefficient and β stiffness index), and echocardiography were assessed to evaluate CVD. Routine biochemical parameters, fibroblast growth factor-23 (FGF23) and high sensitive C- reactive protein were measured to determine cardiovascular risk factors.
  
  
  RESULTS
  Hypertension was found in 12 patients (48 %). Patients had higher FGF23 levels and aPWV-standard deviation score (SDS) as compared to the controls (p = 0.003 and p = 0.002, respectively). Aortic PWV-SDS was predicted by increased daytime systolic blood pressure load (β = 0.512, p = 0.009, R2= 0.262). Neither cIMT nor distensibility differed between the groups; however, older age and high level of FGF23 were independent predictors of β stiffness index in patients (β = 0.507, p = 0.005, R2= 0.461 and β = 0.502, p = 0.005, R2= 0.461, respectively). As compared to controls, patients had worse left ventricular diastolic function [lower E/A ratio p = 0.006) and increased left atrial dimension (p < 0.001)].
  
  
  CONCLUSIONS
  Cardiovascular deteriorations appear in children with stage-2 CKD. Good control of BP and decreasing the level of FGF23 may be useful to slow down the progression of cardiovascular complications.
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey. drmtasdemir@hotmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Taşdemir
authors.affiliation: Department of Pediatric Cardiology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Ayşe Güler
authors.initials: AG
authors.lastname: Eroğlu
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Nur
authors.initials: N
authors.lastname: Canpolat
authors.affiliation: Department of Biochemistry, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Dildar
authors.initials: D
authors.lastname: Konukoğlu
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Ağbaş
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Meltem Dönmez
authors.initials: MD
authors.lastname: Sevim
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Salim
authors.initials: S
authors.lastname: Çalışkan
authors.affiliation: Department of Pediatric Nephrology, Cerrahpaşa School of Medicine, İstanbul University, Cerrahpaşa, Kocamustafapaşa, İstanbul, 34098, Turkey.
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D008297:Male; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Arterial stiffness; Cardiovascular disease; Children; Chronic kidney disease; Diastolic dysfunction; Hypertension
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