Flow-mediated vasodilatation of the brachial artery in children with chronic kidney disease

Abstract

We sought to determine flow-mediated vasodilatation (FMD) of the brachial artery and to assess the relationship of FMD with multiple demographic, clinical and biochemical parameters and cardiac and vascular structure and function in children with chronic kidney disease (CKD) stages 2-4. Forty-three patients, aged 6-20 years, with CKD [mean glomerular filtration rate (GFR) 47 +/- 21 ml/min per 1.73 m2 body surface area, range 16-89 ml/min per 1.73 m2] and 34 healthy age-matched controls were included and studied cross-sectionally between 2001 and 2005. The peak FMD was similar in the CKD and control subjects (mean 6.3% vs 6.7%, P = 0.85). However, abnormally low FMD (< 1.1%) was found in ten (23%) children with CKD. Among children with CKD, those with low FMD were younger, shorter, lighter, and had lower body mass index (BMI) than children with normal FMD, but the difference reached statistical significance only for weight and BMI. Serum triglyceride levels were significantly lower in those with low FMD; otherwise, the two groups were similar with respect to multiple clinical and biochemical parameters. Cardiac and vascular structure was similar in children with normal and low FMD. In conclusion, children with CKD stage 2-4 appear to have increased prevalence of decreased FMD of the brachial artery. However, our study identified few significant factors associated with low FMD in children with CKD.

Effect of cholecalciferol on local arterial stiffness and endothelial dysfunction in children with chronic kidney disease

“…Likewise, the other studies demonstrating decreased FMD in CKD children [36], we observed significantly lower FMD in the patient group. Wilson et al reported no significant risk factor for low FMD in children with CKD [37]. In contrast, we found a negative correlation with FMD and vWf in keeping with previous studies [38].…”

Cardiovascular Disease in CKD in Children: Update on Risk Factors, Risk Assessment, and Management

“…Early work in children indicated promise in this regard, with several small studies demonstrating decreased FMD in patients with advanced CKD (predialyisis, dialysis, and post-transplant)107–110. However, a more recent study of children with less severe kidney impairment (CKD stage 2–4) was less promising regarding the promise of FMD as a marker of early vascular changes, with median FMD similar to that of healthy controls111.…”

Hypertension in Children with Chronic Kidney Disease

“…Independent of the RAAS and fluid overload, increased sympathetic activity, possibly related to renal ischemia or other undefined mechanisms, leads to an increase in vascular resistance. The vascular endothelial cell dysfunction that is observed in children with CKD [32] may impair compensatory vasodilatation and further promote increased vascular resistance. Impaired nitric oxide synthesis appears to play a role in the observed vascular endothelial cell dysfunction and may be related to hyperparathyrodism or alterations in asymmetric dimethylarginine [33].…”