One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.

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We present the case of a newborn diagnosed with perinatal asphyxia and secondary renal injuries, transposition of the great vessels and low systemic blood flow, treated with Prostaglandin, atrioseptostomy, followed by arterial switch surgery After the cardiac surgery the patient is oliguric and requires hemodiafiltration for 12 days, after which renal function is restored. In evolution, however, AVB (atrioventricular block) grade III occurs, followed by implantation of permanent pacemaker, but another postoperative complication – chylothorax – leads to stopping electrical stimulation followed by severe cardiac dysfunction and, consequently, recurrent renal injury and anuria. Re-establishing hemodiafiltration for another 7 days without recovery of renal function. Perinatal asphyxia, cardiac heart disease with low systemic blood flow, prostaglandin, atrioseptostomy, cardiac rhythms disturbances, chylothorax, sepsis, cardiac arrest are intriguing factors that bring renal injury. Their association greatly decreases the chance of survival even if the patient benefits from supportive treatment and early hemodiafiltration.