Cardiovascular Disease in Children with Chronic Kidney Disease

Abstract

More than a decade ago, cardiovascular disease (CVD) was recognized as a major cause of death in children with advanced CKD. This observation has sparked the publication of multiple studies assessing cardiovascular risk, mechanisms of disease, and early markers of CVD in this population. Similar to adults, children with CKD have an extremely high prevalence of traditional and uremia-related CVD risk factors. Early markers of cardiomyopathy, such as left ventricular hypertrophy and dysfunction, and early markers of atherosclerosis, such as increased carotid artery intima-media thickness, carotid arterial wall stiffness, and coronary artery calcification, are frequently present in these children, especially those on maintenance dialysis. As a population without preexisting symptomatic cardiac disease, children with CKD potentially receive significant benefit from aggressive attempts to prevent and treat CVD. Early CKD, before needing dialysis, is the optimal time to both identify modifiable risk factors and intervene in an effort to avert future CVD. Slowing the progression of CKD, avoiding long-term dialysis and, if possible, conducting preemptive transplantation may represent the best strategies to decrease the risk of premature cardiac disease and death in children with CKD.

Endothelial Dysfunction in Children with Steroid-Resistant Nephrotic Syndrome

“…Nevertheless, the effect of long exposure to disease could persist even after remission, as shown in previous studies (10). We excluded children with stage 2 CKD (or above) in order to avoid the confounding effect of impaired renal function in the cardiovascular system (16).…”

Cardiovascular risk factors and mortality in children with chronic kidney disease

“…[1][2][3] CVD is the most common cause of death among paediatric patients with end-stage renal disease (ESRD). [4,5] Traditional and non-traditional cardiovascular risk factors (CVRFs) play an important role in the initiation and progression of CVD in children with CKD. Combinations of these risk factors could cause accelerated manifestations of cardiac and vascular changes in children.…”

“…[3,6] Nontraditional CVRFs including anaemia, fluid overload, dysregulated mineral bone metabolism (hyperparathyroidism, increased calciumphosphate product), hypoalbuminaemia, inflammation (increased C-reactive protein and cytokines) and oxidative stress are more evident in children with moderate to severe CKD. [1,[5][6][7][8][9] Other risk factors for CVD are potentially treatment related, such as calcium overload from dialysate, calcium-based phosphate binders and vitamin D therapy. [10][11][12] In adults with ESRD, coronary artery disease and cardiomyopathy are the leading cause of CVD mortality.…”

Left ventricular hypertrophy in children and adolescents with arterial hypertension

“…In children with CKD, there are multiple factors favoring LVH development, including AH, increased arterial stiffness and diastolic dysfunction of the heart. As LVH is occasionally found in adults with a history of kidney disease in childhood, echocardiographic monitoring at 6-to 12-month intervals is recommended in CKD patients and those on dialysis, along with reducing other CVD risk factors 34 .…”