High prevalence of the metabolic syndrome and associated left ventricular hypertrophy in pediatric renal transplant recipients

Wilson, Amy C.; Greenbaum, Larry A.; Barletta, Gina Marie; Chand, Deepa H.; Lin, Jen Jar; Patel, Hiren P.; Mitsnefes, Mark

doi:10.1111/j.1399-3046.2009.01141.x

Cited by 72 publications

(58 citation statements)

References 28 publications

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“…93 A study from the Midwest Pediatric Nephrology Consortium using data from six centers determined that 68% of children with healthy weight and 80% of overweight/obese children had uncontrolled BP ($95th percentile for age, sex, and height) 1 year after transplantation. 94 Similarly, recent data from the ESPN/ERA-EDTA registry on BP control among pediatric ESRD patients in Europe confirmed a high rate of hypertension in pediatric transplant recipients: hypertension was diagnosed in 66.9% with more than one-third having elevated BP despite being on antihypertensive therapy. 95 Sinha et al 96 conducted a retrospective analysis of all current pediatric kidney transplant patients in the United Kingdom, with data collected at 6 months and 1, 2, and 5 years after transplantation: the rate of uncontrolled hypertension has been unchanged (25%-27%) during follow-up.…”

Section: Hypertension In the Pediatric Transplant Recipient Or Recipimentioning

confidence: 89%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

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Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drugdrug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

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Section: Hypertension In the Pediatric Transplant Recipient Or Recipimentioning

confidence: 89%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

View full text Add to dashboard Cite

show abstract

“…However, the etiology of CKD in children is different than in adults; congenital abnormalities of the urinary tract account for most cases of pediatric CKD, whereas hypertensive and diabetic nephropathy, the leading causes of CKD in adults, are quite rare in children. Despite this difference in etiology, up to 21% of children have multiple CVRF at time of transplant, with 40% of patients affected at 1 year post transplant (21). There are few published data regarding prevalence and disease-specific correlates of multiple CVRF in children with earlier stages of CKD.…”

Section: Introductionmentioning

confidence: 98%

Prevalence and Correlates of Multiple Cardiovascular Risk Factors in Children with Chronic Kidney Disease

Wilson

Schneider

Cox

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Although prevalence of traditional cardiovascular risk factors (CVRF) has been described in children with CKD, the frequency with which these CVRF occur concomitantly and the clinical characteristics associated with multiple CVRF are unknown. This study determined the prevalence and characteristics of multiple CVRF in children in the Chronic Kidney Disease in Children study.Design, setting, participants, & measurements Using cross-sectional data from first follow-up visits, we determined the prevalence of four CVRF: hypertension (casual BP Ͼ95 th percentile or self-reported hypertension with concurrent use of anti-hypertensive medication), dyslipidemia (triglycerides Ͼ130 mg/dl, HDL Ͻ40 mg/dl, non-HDL Ͼ160 mg/dl, or use of lipid-lowering medication), obesity (BMI Ͼ95 th percentile), and abnormal glucose metabolism (fasting glucose Ͼ110 mg/dl, insulin Ͼ20 IU/ml, or HOMA-IR Ͼ2.20, Ͼ3.61, or Ͼ3.64 for those at Tanner stage 1, 2 to 3, or 4 to 5, respectively) in 250 children (median age 12.2 years, 74% Caucasian, median iohexol-based GFR 45.2 ml/min per 1.73 m 2 ).Results Forty-six percent had hypertension, 44% had dyslipidemia, 15% were obese, and 21% had abnormal glucose metabolism. Thirty-nine percent, 22%, and 13% had one, two, and three or more CVRF, respectively. In multivariate ordinal logistic regression analysis, glomerular disease and nephrotic-range proteinuria were associated with 1.96 (95% confidence interval, 1.04 to 3.72) and 2.04 (95% confidence interval, 0.94 to 4.43) higher odds of having more CVRF, respectively. ConclusionsWe found high prevalence of multiple CVRF in children with mild to moderate CKD. Children with glomerular disease may be at higher risk for future cardiovascular events.

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“…For example, a recent multicenter study determined that 38% of kidney transplant recipients had at least three traditional cardiovascular risk factors. 21 …”

Section: Traditional Risk Factorsmentioning

confidence: 99%

“…Data from the International Pediatric Peritoneal Dialysis Network registry 31 on 507 patients report the overall prevalence of LVH to be 48%. A Midwest Pediatric Nephrology Consortium study, 21 utilizing data from six centers, demonstrated the prevalence of LVH to be 40% in children 1-year post-transplant. Most of these studies show the persistence of cardiac hypertrophy, [32][33][34] but some report improvement post-transplant.…”

Section: Lvh Is the Most Common Cardiac Abnormality In Children With Ckdmentioning

confidence: 99%

Cardiovascular Disease in Children with Chronic Kidney Disease

Mitsnefes

2012

Journal of the American Society of Nephrology

324

149

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More than a decade ago, cardiovascular disease (CVD) was recognized as a major cause of death in children with advanced CKD. This observation has sparked the publication of multiple studies assessing cardiovascular risk, mechanisms of disease, and early markers of CVD in this population. Similar to adults, children with CKD have an extremely high prevalence of traditional and uremia-related CVD risk factors. Early markers of cardiomyopathy, such as left ventricular hypertrophy and dysfunction, and early markers of atherosclerosis, such as increased carotid artery intima-media thickness, carotid arterial wall stiffness, and coronary artery calcification, are frequently present in these children, especially those on maintenance dialysis. As a population without preexisting symptomatic cardiac disease, children with CKD potentially receive significant benefit from aggressive attempts to prevent and treat CVD. Early CKD, before needing dialysis, is the optimal time to both identify modifiable risk factors and intervene in an effort to avert future CVD. Slowing the progression of CKD, avoiding long-term dialysis and, if possible, conducting preemptive transplantation may represent the best strategies to decrease the risk of premature cardiac disease and death in children with CKD.

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High prevalence of the metabolic syndrome and associated left ventricular hypertrophy in pediatric renal transplant recipients

Abstract: metabolic syndrome is common at time of pediatric kidney transplant, and prevalence rises sharply at one-yr post-transplant. The presence of metabolic syndrome is strongly associated with LVH in these patients.

Cited by 72 publications

References 28 publications

Assessment and Management of Hypertension in Transplant Patients

Assessment and Management of Hypertension in Transplant Patients

Prevalence and Correlates of Multiple Cardiovascular Risk Factors in Children with Chronic Kidney Disease

Cardiovascular Disease in Children with Chronic Kidney Disease

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