Incidence and magnitude of post‐transplant cardiovascular disease after pediatric kidney transplantation: Risk factor analysis of 1058 pediatric kidney transplants at the university of Minnesota

Serrano, Oscar K.; Bangdiwala, Ananta S; Vock, David M.; Chinnakotla, Srinath; Dunn, Ty B.; Finger, Erik B.; Kandaswamy, Raja; Pruett, Timothy L.; Najarían, John S.; Matas, Arthur J.; Chavers, Blanche M.

doi:10.1111/petr.13283

Cited by 10 publications

(13 citation statements)

References 34 publications

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“…Additionally, from this finding, it could be speculated that factors post-transplantation (e.g., impaired microcirculation, neurotoxic and vasoactive immunosuppressive therapy) may have further detrimental effects on brain structure and neurocognitive functioning [7][8][9]. The idea that an impaired microcirculation (e.g., due to hypertension or vaso-active medication) is implicated in the development of white matter abnormalities and associated neurocognitive impairments post-transplantation is consistent with previous work showing that the burden of cardiovascular disease increases with longer time since transplantation [33] and that cardiovascular risk factors are both related to lower white matter integrity and neurocognitive problems [34,35].…”

Section: Discussionsupporting

confidence: 85%

Risk factors for neurocognitive impairment and the relation with structural brain abnormality in children and young adults with severe chronic kidney disease

et al. 2022

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Background Severe chronic kidney disease (CKD) in children and young adults has shown to be associated with abnormal brain development, which may contribute to neurocognitive impairments. We aimed to investigate risk factors for neurocognitive impairment and investigate the relation with structural brain abnormalities in young severe CKD patients. Methods This cross-sectional study includes 28 patients with severe CKD (eGFR < 30), aged 8–30 years (median 18.5 years), on different treatment modalities (pre-dialysis [n = 8], dialysis [n = 8], transplanted [n = 12]). We assessed neurocognitive functioning using a comprehensive test battery and brain structure by magnetic resonance imaging metrics of brain volume and white matter integrity (fractional anisotropy [FA] and mean diffusivity [MD] measured with diffusion tensor imaging). Multivariate regression and mediation analyses were performed between clinical CKD parameters, brain structure, and neurocognitive outcome. Results A combination of risk factors (e.g., longer time since kidney transplantation, longer dialysis duration and late CKD onset) was significantly associated with lower intelligence and/or worse processing speed and working memory. Lower FA in a cluster of white matter tracts was associated with lower intelligence and mediated the relation between clinical risk factors and lower intelligence. Conclusions Young severe CKD patients with a prolonged duration of kidney replacement therapy, either dialysis or transplantation are at particular risk for impairments in intelligence, processing speed, and working memory. Disrupted white matter integrity may importantly contribute to these neurocognitive impairments. Prospective, longitudinal studies are needed to elucidate the mechanisms involved in CKD and treatment that affect white matter integrity and neurocognitive outcome in young patients. Graphical abstract

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Section: Discussionsupporting

confidence: 85%

Risk factors for neurocognitive impairment and the relation with structural brain abnormality in children and young adults with severe chronic kidney disease

et al. 2022

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“…26,27 However, these patients remain at risk for early adult-onset cardiovascular events. 28-30 As demonstrated in this study, close to 30% of patients with chronic medical conditions were obese and 39% were found to have new-onset HTN or persistent HTN on antihypertensive medication during the visit. Many of these patients have suboptimal diet and exercise habits and were not screened for lipid abnormalities (Tables 2 and 3).…”

Section: Discussionmentioning

confidence: 56%

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

Kaplinski

Griffis

Liu

et al. 2020

Clin Pediatr (Phila)

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Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.

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“…KTx is the treatment of choice for children with kidney failure with highly beneficial overall effects. However, complex mechanisms -including hypertension, increased arterial stiffness, components of metabolic syndrome, consequences of immunosuppressive therapy, and chronic graft dysfunction -are responsible for an elevated CV disease burden [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Kidney transplantation (KTx) offers improved patient survival and quality of life compared to chronic dialysis; however, pediatric KTx recipients still remain at risk of higher rates of cardiovascular (CV) events throughout their lives. In fact, sudden cardiac arrest, arrhythmias, or myocardial infarction are responsible for 9–45% of premature deaths in the pediatric kidney allograft population [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography

et al. 2022

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Background Kidney transplantation (KTx) improves prognosis in children with kidney failure; still, these patients are prone to cardiovascular damage due to multiple risk factors. Our aim was to assess myocardial structure and function in pediatric KTx by conventional and speckle-tracking echocardiography (STE) in association with established cardiovascular risk factors. Methods Forty-two KTx and 39 healthy age- and gender-matched children were evaluated. KTx recipients were further categorized according to the control of hypertension assessed by 24-h ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography, and 2-dimensional STE. Left and right ventricular (LV, RV) global longitudinal strain (GLS), and LV circumferential strain (GCS) were measured. Glomerular filtration rate (eGFR) was calculated according to the Schwartz formula. Results KTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi) while LVGLS was significantly lower, whereas LVGCS and RVGLS were increased in KTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-h SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy, eGFR, and HOMA-IR were independent determinants of LVGLS. Conclusions Cardiac morphology and function show distinct changes after KTx. Along with comparable ventricular volumes, LV hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and kidney graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric KTx. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

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Incidence and magnitude of post‐transplant cardiovascular disease after pediatric kidney transplantation: Risk factor analysis of 1058 pediatric kidney transplants at the university of Minnesota

Abstract: A pretransplant history of CVD and a failed graft are significant risk factors for the development of post-transplant CVE. CVD increases the risk of post-transplant death or graft loss.

Cited by 10 publications

References 34 publications

Risk factors for neurocognitive impairment and the relation with structural brain abnormality in children and young adults with severe chronic kidney disease

Risk factors for neurocognitive impairment and the relation with structural brain abnormality in children and young adults with severe chronic kidney disease

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography

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