Cardiovascular disease as a late complication of end-stage renal disease in children

Abstract

As in older adults, cardiovascular disease is the most important cause of death in adolescents and young adult patients with end-stage renal disease (ESRD) since childhood. This concerns patients on dialysis as well as transplant patients, despite the fact that a long duration of dialysis during childhood is an extra mortality risk factor. Left ventricular hypertrophy (LVH), aortic valve calcification, and increased arterial stiffness, but not increased arterial intima media thickening, are the most frequently observed alterations in young adult survivors with childhood ESRD. In transplanted patients a concentric LVH as a result of chronic hypertension is mostly observed; in dialysis patients a more asymmetric septal LVH is found as a result of chronic volume overload. These results suggest that in children and young adults with ESRD chronic pressure and volume overload, a high calcium-phosphate product, and chronic inflammation, but not dyslipidemia, play a role in the development of cardiovascular disease.

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).…”

Assessment and Management of Hypertension in Patients on Dialysis

“…Data from the Late Effects of Renal Insufficiency in Children cohort study of 249 Dutch adult patients with onset of ESRD between 0 and 14 years of age demonstrated that the overall mortality risk of the patients with ESRD was 31 times that of age-matched Dutch citizens. 179 Cardiovascular disease accounted for 41% of all mortalities, with cardiac death becoming the most common cause of mortality after 10 years of receiving RRT. 179 Similarly, among 1380 patients with childhood-onset ESRD who died before aged 30 years, 23% of deaths were cardiovascular in origin; the cardiovascular death rate was 1000 times higher among children with ESRD than in the general population, and was 100 times higher among young adults with ESRD than in the general population.…”

“…179 Cardiovascular disease accounted for 41% of all mortalities, with cardiac death becoming the most common cause of mortality after 10 years of receiving RRT. 179 Similarly, among 1380 patients with childhood-onset ESRD who died before aged 30 years, 23% of deaths were cardiovascular in origin; the cardiovascular death rate was 1000 times higher among children with ESRD than in the general population, and was 100 times higher among young adults with ESRD than in the general population. 180 Although the number of patients with childhood-onset ESRD is small compared with the overall adult ESRD population, they constitute a unique group in whom control of cardiovascular risk factors is key to ensuring long-term survival.…”

Evaluation of Ultrasensitive C-Reactive Protein as a Cardiovascular Risk Marker in Pediatric Patients with End-Stage Renal Disease on Peritoneal Dialysis

“…Therefore, these factors are inadequate to characterize risk of cardiovascular damage in the pediatric population [41]. In our series, the most frequent risk factors were dyslipidemia, elevated HOMA, HT, and hyperparathyroidism, and the association with cardiovascular damage was adequate.…”