Prospective analysis of carotid arterial wall structure in pediatric renal transplants with ambulatory normotension and in treated hypertensive recipients*

Krmar, Rafael T.; Balzano, Rita; Jogestrand, Tomas; Cedazo-Minguez, Ángel; Englund, Marita; Berg, Ulla

doi:10.1111/j.1399-3046.2007.00837.x

Cited by 38 publications

(26 citation statements)

References 47 publications

(85 reference statements)

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“…Thus, APWV and AI might remain elevated in the period post-RT. However, it is possible that decrease in arterial stiffness markers occurs later post-transplant as suggested by others [36][37][38]. In our study we found a correlation between APWV, AI, and graft function 6 months after RT.…”

Section: Discussionsupporting

confidence: 71%

Aortic stiffness in ESRD children before and after renal transplantation

et al. 2010

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Cardiovascular complications are the main cause of death in end-stage renal failure in adult patients, but those complications start in childhood. Renal transplantation (RT) seems to reduce or even reverse certain abnormalities seen in dialyzed patients. Since RT seems to correct metabolic abnormalities that play a role in cardiovascular disease, aortic pulse wave velocity (APWV) was used to evaluate aortic stiffness before and after RT. We included 15 children on chronic hemodialysis (HD), aged 11.1 +/- 4.8 years and dialysis duration was 12.9 +/- 7.4 months. APWV was performed every 6 months before RT and 6 months after. There was no significant difference in APWV (6.1 +/- 1.3 m/s vs 6.5 +/- 1.4 m/s) and augmentation index (AI) on HD and 6 months after RT. APWV pre-transplant was not correlated with time on HD, but increased with age (p = 0.016). No correlation between APWV pre-/post-transplant and other HD parameters or calcineurin inhibitor exposure were found. Only graft function was inversely correlated with APWV post-transplant (p = 0.02). In conclusion, aortic stiffness seems to remain stable before and 6 months after pediatric RT. Graft function was inversely correlated with APWV. Differences in vessel structure among children of the same age group and increase in aortic stiffness with age may jeopardize data interpretation.

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Section: Discussionsupporting

confidence: 71%

Aortic stiffness in ESRD children before and after renal transplantation

et al. 2010

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“…The only significant predictor of carotid IMT after Rtx was systolic blood pressure. In another prospective study of 31 children after Rtx, it was found that CCA-IMT did not change in children after mean of 4 years after Rtx despite good blood pressure control and relatively good graft function [107]. However, when interpreting this data, it should kept in mind that CCA-IMT increases with age at a rate of 0.01-0.005 mm per year.…”

Section: Is Intima-media Thickening Reversible?mentioning

confidence: 81%

Intima–media thickness measurements in children with cardiovascular risk factors

2009

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Measuring intima-media thickness (IMT) is now a standard diagnostic procedure in assessing cardiovascular risk and hypertensive target-organ damage (TOD) in adults. There is also an increasing number of pediatric publications evaluating IMT in children from high-risk groups, such as those with arterial hypertension, diabetes, chronic kidney disease, obesity, dyslipidemia, and homocystinurias. It has been shown that carotid IMT is strongly related with other markers of TOD in children with arterial hypertension and with metabolic cardiovascular risk factors. In children with coarctation of the aorta, carotid IMT correlated both with blood pressure and even with mild residual aortic gradient. On the other hand, studies in children with high cardiovascular risk have shown that normalization of blood pressure and metabolic abnormalities led to regression of arterial changes and decrease of IMT. Although not yet accepted as standard pediatric procedure, IMT measurement is emerging as a promising method of assessing TOD and cardiovascular risk and monitoring treatment efficacy. From a practical point of view, clinical utility of IMT measurements seems to be similar to use of echocardiography in assessing left ventricular mass. However, IMT measurements in children and adolescents should be standardized to avoid bias caused by the use of different measurement methods.

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“…In contrast, Suwelack et al [27] showed high cIMT in a population of renal transplant patients with normal blood pressure during hemodialysis and after transplantation. Krmar and colleagues [28] believed that higher cIMT in pediatric renal transplantation was not related to BP but to the possibility of other influences. In our study there was no relationship between BP and cIMT.…”

Section: Discussionmentioning

confidence: 98%

Subclinical atherosclerosis and related risk factors in renal transplant recipients

et al. 2010

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Long-term survival after successful renal transplantation is shortened by cardiovascular disease. Cardiovascular disease is a main cause of morbidity and death among children and young adults after renal transplantation. The aim of our study was to measure the carotid intima media thickness (cIMT) and determine its relationship to the risk factors for early arteriopathy in renal transplant recipients. Sixty-six stable renal transplant patients (36 female and 30 male), 7-25 years of age (mean 18.3 +/- 4.5 years) were enrolled in this study. The cIMT was measured by high-resolution B mode ultrasonography in multiple projections. The results were correlated with clinical and paraclinical parameters, including age, gender, body mass index (BMI), blood pressure, glomerular filtration rate (GFR), duration of dialysis, duration of chronic kidney disease (CKD), post-transplantation interval, calcium-phosphate (CaxP) product, cumulative dose of Ca-based P binder and calcitriol, lipid profile, uric acid, and cyclosporine level. The mean post-transplantation follow-up period was 64 +/- 40 months. The mean cIMT standard deviation score (SDS) of the patients and the control group was 0.60 +/- 0.81 mm (range -1.10 mm to 2.75 mm) and -1.25 +/- 0.95 mm (range -3.23 mm to 0.26 mm), respectively. Renal transplant recipients had a significantly greater cIMT than that of the controls (P < 0.001). Among several risk factors, there were positive correlations between cIMT SDS and gender, and cumulative dose of calcitriol (P = 0.02 and P = 0.02, respectively). In conclusion, subclinical atherosclerosis is present in young transplant recipients. Non-invasive monitoring of cIMT in renal transplant patients for the detection of early vascular lesions might be of value in preventing cardiovascular disease. Further studies are needed to see if proper monitoring of vitamin D therapy before and after transplantation could be helpful in the prevention of arteriopathy in renal transplant recipients.

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Prospective analysis of carotid arterial wall structure in pediatric renal transplants with ambulatory normotension and in treated hypertensive recipients*

Cited by 38 publications

References 47 publications

Aortic stiffness in ESRD children before and after renal transplantation

Aortic stiffness in ESRD children before and after renal transplantation

Intima–media thickness measurements in children with cardiovascular risk factors

Subclinical atherosclerosis and related risk factors in renal transplant recipients

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