Increased Arterial Stiffness in Young Adults with End-Stage Renal Disease since Childhood

Abstract

Abstract. Increased arterial stiffness is a risk factor for mortality in adults over 40 yr of age with end-stage renal disease (ESRD). As no data exist on vascular changes in young adults with ESRD since childhood, a long-term outcome study was performed. All living Dutch adult patients with onset of ESRD between 1972 and 1992 at age 0 to 14 yr were invited for carotid artery and cardiac ultrasound and BP measurements. Data on clinical characteristics were collected by review of all medical charts. Carotid ultrasound data were compared with those of 48 age-matched and gender-matched healthy controls. Carotid artery and cardiac ultrasound was performed in 130 out of 187 eligible patients. Mean age was 29.0 (20.7 to 40.6) yr. Compared with controls, patients had a similar intima media thickness but a reduced mean arterial wall distensibility DC (40.0 versus 45.0 kPa Ϫ1 · 10 Ϫ3 ; 95% CI, Ϫ9.1 to Ϫ0.8; P Ͻ 0.001), an increased stiffness parameter ␤ (4.2 versus 3.8; 95% CI, 0.05 to 0.68; P ϭ 0.02), an increased elastic incremental modulus E inc (0.35 versus 0.27 kPa · 10 3 ; 95% CI, 0.02 to 0.12; P Ͻ 0.001). Multiple regression analyses in all subjects revealed that ESRD was associated with an increase in ␤ and E inc . Arterial wall properties of patients currently on dialysis and transplanted patients were comparable. In all patients, current systolic hypertension was associated with increased E inc and decreased DC. In conclusion, carotid arterial wall stiffness is increased in young adult patients with pediatric ESRD. Hypertension is a main determinant and might be a target for treatment of these potentially lethal arterial wall changes.Cardiovascular disease is the main cause of death in adults with end-stage renal disease (ESRD) (1-4). Cardiovascular causes of death are relatively uncommon under the age of 40 yr in the general population. Yet, cardiovascular diseases also account for most deaths in patients with ESRD aged between 25 and 44 yr (1). There are indications that even in children and young adults with ESRD since childhood, cardiovascular disease is the main cause of death, similar to older ESRD patients. We performed a long-term follow up study on the somatic, social, and psychologic outcome of children with ESRD. Over 25% of all patients had died, all of them under the age of 36 yr. We found cardiovascular disease to be the most important cause of death in the whole group, and cardiac death most prominent in those patients who died more than 10 yr after beginning renal replacement therapy (RRT) (5).Clinical studies have shown that increased stiffness of the large arteries independently contributes to the high mortality in dialysis patients over 40 yr of age (6 -8). Recently, studies performed with electron beam CT have shown coronary calcifications in adolescents and young adults with ESRD (9 -11). However, these studies concern only a few patients; to date, no data exist on arterial wall distensibility in young adult patients with ESRD since childhood. The purpose of this study was to assess the pre...

Mineral Metabolism and Vascular Damage in Children on Dialysis

“…In young adults with childhood-onset CKD, Groothoff et al 30 reported a significant increase in arterial stiffness but normal IMT, whereas a similar study by Oh et al 31 showed increased IMT and calcification in 92% of his cohort. However, these studies in young adults can support only speculations of the potential changes in children who are on dialysis because it is possible that uremia multiplies the natural age-related vascular damage.…”

Abnormal Carotid Artery Structure and Function in Children and Adolescents With Successful Renal Transplantation

“…Recent studies in adults who developed end-stage renal disease (ESRD) during childhood found a high prevalence of asymptomatic atherosclerosis as demonstrated by abnormal intima-media thickness (IMT) and arterial wall compliance. 3,4 However, from those studies, it is not possible to determine when arterial abnormalities develop.…”

Posttransplant Hypertension: Multipathogenic Disease Process

“…These arterial wall abnormalities, indicators of arterial dysfunction, are comparable to those measured in the transplant patients with the same risk factors. 60 Mistnefes and coworkers confirmed these findings in a recent study. 61 In their study, these markers of atherosclerosis were associated with higher mean systolic blood pressures taken within 1 year before the study, higher daytime systolic blood pressure load (via ambulatory blood pressure monitoring), number of kidney transplants, and deceased-donor transplants.…”

“…[1][2][3] It represents a strong predictor of renal and patient cardiovascular outcomes 1,3,5,6,8,[11][12][13]15,17,35,56,58,[60][61][62][63] ( Figure 2). Therefore, posttransplant hypertension represents a multipathogenic process that amplifies a vicious cycle where allograft and cardiovascular outcomes in kidney transplant recipients are determined by the interaction of 2 distinct donor and recipient genetic make-ups, and the inherited cardiovascular and renal risk factors from earlier phases and new recipient and donor-related environmental and demographic variables that may occur during implantation and posttransplant (Figure 1).…”