Traditional and “new” cardiovascular risk markers and factors in pediatric dialysis patients

Abstract

Cardiovascular disease (CVD) is the principal cause of mortality in patients with end-stage renal disease (ESRD). The aim of this study was to analyze carotid intima-media thickness (cIMT), endothelium-dependent dilatation (EDD), and left ventricular mass index (LVMI) as the cardiovascular risk markers and to investigate the independent risk factors of these markers in pediatric dialysis patients. This study included 39 children and adolescents undergoing dialysis (15 hemodialysis and 24 peritoneal dialysis) and 15 age- and gender-matched healthy subjects. The cIMT and EDD were assessed by high-resolution ultrasound, and LVMI was calculated from standard echocardiographic measurements. Compared with control subjects, cIMT standard deviation scores (SDS), LVMI, total homocysteine (tHcy), and high-sensitivity C-reactive protein (hs-CRP) values were significantly higher in patients, but EDD values did not differ. The mean hs-CRP level was significantly higher in hemodialysis (HD) patients than in peritoneal dialysis (PD) patients. The cIMT-SDS and LVMI were associated with several variables in univariate analysis. Stepwise linear regression analysis, indexed SBP (p = 0.017), and hemoglobin (p = 0.001) turned out to be independent variables for predicting LVMI, and a significant predictor of cIMT was indexed diastolic blood pressure (DBP) (p = 0.035). The causes of atherosclerosis and left ventricular hypertrophy are multifactorial in children and adolescents with ESRD. Better management of hypertension and anemia may be priorities for preventing or improving CVD in these patients.

Relationship between peritoneal permeability with inflammation and subclinical atherosclerosis in peritoneal dialysis patients

“…Elevated serum concentrations of CRP is another marker used to stratify CV risk by reflecting chronic inflammation in adult and pediatric CKD and dialysis patients (9,(21)(22)(23). Both CIMT and CRP are found to be elevated in pediatric and adult dialysis patients in recent studies (24)(25)(26)(27). In our study, although CIMT was not different between groups, correlation analysis yielded CRP and age to be independent determinants of CIMT in high transport group.…”

Hypertension in Pediatric Long-term Hemodialysis Patients in the United States

“…A retrospective study of 64 pediatric long-term dialysis patients found that, by multivariate logistic regression analysis, higher systolic BP remained in the final model as an independent predictor of left ventricular hypertrophy with a borderline level of significance (18). Similarly, a recent study of 39 Turkish pediatric long-term dialysis patients found systolic hypertension to be an independent risk factor for increased left ventricular mass index, and diastolic hypertension to be a predictor of carotid intima-media thickness (19).…”

“…Hypertension is a risk factor for cardiovascular disease in adult and pediatric ESRD patients (9,(17)(18)(19). A study of 432 adult ESRD patients found that each 10 mmHg rise in mean arterial BP was independently associated with presence of concentric left ventricular hypertrophy, change in left ventricular mass index, change in cavity volume, and development of de novo cardiac failure and ischemic heart disease on follow-up echocardiography (17).…”

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

“…Increased LVMI is defined as an increase in the mass of the left ventricle, which can be secondary to an increase in wall thickness, an increase in cavity size, or both. This increase in mass predominantly results from a chronic increase in the afterload of the left ventricle caused by hypertension and/or by chronic volume load (23)(24)(25). Aortic annulus diameter enlargement has been reported in children with hypertension other than Turner and Marfan syndromes (26,27).…”