Cardiovascular Disease as a Late Complication of End-Stage Renal Disease in Children

Abstract

♦ Objective To analyze the late cardiovascular outcome of end-stage renal disease (ESRD) in children. ♦ Design A nation-wide long-term follow-up study. Determinants of outcomes and causes of death were retrospectively assessed. Patients underwent assessment of overall health state, B- and M-mode ultrasound of the carotid arteries, and echocardiography for cross-sectional analysis. ♦ Results We analyzed the medical course of all 249 adult Dutch patients with ESRD onset between 1972 and 1992 at age 0 – 14 years, and who were born before 1979. Of the 187 living patients, 140 participated in the cross-sectional part of the study. The standardized mortality rate was 31.0. Overall 5-, 10-, and 20-year survival after ESRD onset was 87%, 82%, and 78%, respectively. Cardiovascular disease accounted for most deaths (41%). In the whole group, left ventricular hypertrophy (LVH), aortic valve calcification, and arterial wall stiffening were highly prevalent. LVH was associated with hypertension at time of assessment. Aortic valve calcification was strongly associated with a long total duration of peritoneal dialysis (β = 0.33, p < 0.001). Arterial wall pathology was not associated with current treatment modality. ♦ Conclusions As in adults, cardiovascular disease is the most important cause of death in children with ESRD. Stricter reduction of volume overload, prevention of high serum calcium–phosphate product, and more vigorous treatment of hypertension are important targets to improve cardiovascular survival in children with ESRD.

Survival analysis of pediatric dialysis patients in Taiwan

“…31 CVD was the most common cause (41%) in the Dutch study as well, in which cerebrovascular accidents (24%) account for most CVD deaths. 5,[31][32][33] Our current study reported a total 23.4% foetal cardiovascular accidents, including cardiovascular (13.0%) and cerebrovascular (10.4%), equal to death caused by infection (23.4%). The reported fatal cerebrovascular accident rate (10.4%) was lower than that in the LERIC study (24%), but higher than that by the USRDS (6%).…”

Kidney Transplantation Without Prior Dialysis in Children: The Eurotransplant Experience

“…Adults with pre-emptive transplantations show a lower mortality rate, especially from cardiovascular conditions, and less morbidity from hypertension and left ventricular hypertrophy (8,17,28). As in adults, the primary cause of mortality in pediatric end-stage renal failure is cardiovascular, associated with hypertension (2,29,30).…”

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

“…Chronic kidney disease in children is not only associated with increased mortality but also contributes to significant long-term morbidity including reduced quality of life, neurodevelopmental delay, growth problems, and cardiac dysfunction. [1][2][3][4][5] While improvements in medical management and renal replacement therapy for pediatric patients with ESRD have resulted in improved overall survival, renal transplantation remains the treatment of choice for this population. 6 This is especially true for the smallest of pediatric recipients, typically those weighing less than 20 kg, for although transplantation in this group is associated with high mortality, graft loss, and ACR, this population has an even higher risk of mortality if maintained on dialysis.…”