Clinical characteristics and prevalence of complications of chronic kidney disease in children: the Taiwan Pediatric Renal Collaborative study

Chou, Hsin Hsu; Lin, Ching Yuang; Chiou, Yee Hsuan; Tain, You‐Lin; Wang, Yi Fan; Wang, Hsin-Hui; Chiou, Yuan Yow

doi:10.1007/s00467-016-3325-5

Cited by 22 publications

(13 citation statements)

References 29 publications

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“…Of note is that up to 48% of children with CKD stage G1 had BP abnormalities on ABPM. Our findings are consistent with previous reports wherein hypertension is extremely prevalent in CKD children, even in an early stage [20][21][22][23]. The present study supported the notion that ABPM is superior to office BP in identifying children with BP abnormalities [24].…”

Section: Discussionsupporting

confidence: 93%

Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease

Hsu

Chang-Chien

Lin

et al. 2020

JCM

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Chronic kidney disease (CKD) is associated with high risk for cardiovascular disease (CVD). Gut microbiota-dependent metabolites trimethylamine (TMA), trimethylamine N-oxide (TMAO), and dimethylamine (DMA) have been linked to CKD and CVD. We examined whether these methylamines are correlated with cardiovascular risk in CKD children. A total of 115 children and adolescents with CKD stage G1–G4 were enrolled in this cross-sectional study. Children with CKD stage G2–G4 had higher plasma levels of DMA, TMA, and TMAO, but lower urinary levels of DMA and TMAO than those with CKD stage G1. Up to 53% of CKD children and adolescents had blood pressure (BP) abnormalities on 24-h ambulatory BP monitoring (ABPM). Plasma TMA and DMA levels inversely associated with high BP load as well as estimated glomerular filtration rate (eGFR). Additionally, CKD children with an abnormal ABPM profile had decreased abundance of phylum Cyanobacteria, genera Subdoligranulum, Faecalibacterium, Ruminococcus, and Akkermansia. TMA and DMA are superior to TMAO when related to high BP load and other CV risk factors in children and adolescents with early-stage CKD. Our findings highlight that gut microbiota-dependent methylamines are related to BP abnormalities and CV risk in pediatric CKD. Further studies should determine whether these microbial markers can identify children at risk for CKD progression.

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Section: Discussionsupporting

confidence: 93%

Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease

Hsu

Chang-Chien

Lin

et al. 2020

JCM

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“…In keeping with previous studies, certain markers of CV risk tend to present in children with CKD, even in an early stage, such as ABPM abnormalities [4,6,7,16], uric acid [17], and AASI [18]. In the current study, up to 47.9% of children with CKD stage G1 displayed abnormal ABPM profiles.…”

Section: Discussionsupporting

confidence: 91%

Association between Acrylamide Metabolites and Cardiovascular Risk in Children With Early Stages of Chronic Kidney Disease

Hsu

Hou

et al. 2020

IJMS

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Cardiovascular disease (CVD) begins early in children with chronic kidney disease (CKD). Reduced nitric oxide (NO) bioavailability has been associated with increased CVD in CKD patients. Children tend to have more exposure to acrylamide, one of the most common toxins in food. We aimed to determine whether urinary levels of acrylamide metabolites N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA) and N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-cysteine (GAMA) are associated with CV risk markers in children with CKD. Data on 112 children and adolescents ages three to 18 years old with CKD stage G1–G4 are reported. We observed that 24 h ambulatory blood pressure monitoring (ABPM) abnormalities were greater, and left ventricular (LV) mass and ambulatory arterial stiffness index (AASI) were higher in children with CKD stage G2–G4 versus G1. Patients with CKD stage G2–G4 had a lower urinary acrylamide level, but a higher AAMA-to-GAMA ratio than those with CKD stage G1. Urinary acrylamide level was negatively associated with high systolic blood pressure (SBP) and diastolic BP (DBP) load on 24 h ABPM. Lower urinary levels of acrylamide, AAMA, and GAMA were correlated with LV mass. Additionally, GAMA are superior to AAMA related to NO-related parameters, namely citrulline and symmetric dimethylarginine (SDMA). This study suggests that determinations of urinary acrylamide level and its metabolites in the early stages of pediatric CKD may identify patients at risk of CVD. Further studies should clarify mechanisms underlying acrylamide exposure to define the treatment for protection against CVD.

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“…Besides, difference in the incidence of primary renal disease may play a role in the differences in mortality rates between countries. Glomerulonephritis and CAKUT form the most common etiologies of renal disease in children, however, in our previous study [ 16 ], glomerular diseases account for nearly half of patients with chronic kidney disease in Taiwan, where glomerulonephritis is present in only 20–30% of patients in Europe [ 5 ] and 30–40% in the United States [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality Risks among Various Primary Renal Diseases in Children and Adolescents on Chronic Dialysis

Chou

Chiou

et al. 2018

JCM

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There is little information available on the association between primary renal disease (PRD) and long-term mortality in the pediatric dialysis population. The objective of this study was to explore mortality risks in children and adolescents on chronic dialysis, specifically focused on the risk of various PRDs. The study cohort included children and adolescents with end-stage renal disease (ESRD) (aged < 20 years) who had received dialysis for at least 90 days between 2000 and 2014 and were identified from Taiwan’s National Health Insurance medical claims. A total of 530 children and adolescents were included in the study. The median age of the included patients was 13.6 years and 305 (57.5%) patients were males. One hundred and seven patients died during the follow-up period and the median survival time was 6.0 years. Mortality was highest in the youngest patients. For patients with the following PRDs, mortality was significantly higher than that in patients with primary glomerulonephritis: secondary glomerulonephritis (adjusted hazard ratio (aHR): 2.50; 95% confidence interval (CI): 1.03–6.08), urologic disorder (aHR: 4.77; 95% CI: 1.69–13.46), and metabolic diseases (aHR: 5.57; 95% CI: 1.84–16.85). Several kinds of PRDs appear to have high mortality risks in the pediatric dialysis population. These differences in mortality risk highlight the importance of the focused clinical management of these high-risk subgroups.

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Clinical characteristics and prevalence of complications of chronic kidney disease in children: the Taiwan Pediatric Renal Collaborative study

Abstract: This study reveals differences in CKD etiology and prevalence of specific complications according to the stage of CKD. Early recognition and awareness of complications are mandatory for clinicians during the follow-up visits of children with CKD.

Cited by 22 publications

References 29 publications

Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease

Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease

Association between Acrylamide Metabolites and Cardiovascular Risk in Children With Early Stages of Chronic Kidney Disease

Mortality Risks among Various Primary Renal Diseases in Children and Adolescents on Chronic Dialysis

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