Management of dyslipidemia in pediatric renal transplant recipients

Bock, Margret; Wall, L.; Dobrec, Carly; Chandran, Mary Moss; Goebel, Jens

doi:10.1007/s00467-019-04428-y

Cited by 11 publications

(9 citation statements)

References 72 publications

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“…The association between CKD and dyslipidemia is frequently reported in the literature 16,19 . After renal transplant, dyslipidemia is believed to contribute to a faster decline of the allograft function, especially when associated with proteinuria 36,37 .…”

Section: Discussionmentioning

confidence: 98%

“…In adults, dyslipidemia and insulin resistance are well-recognized risk factors for renal function decline, which are mainly associated with weight gain and immunosuppressants use after kidney transplant 16 . Studies in adults showed inverse relationships between glomerular filtration rate (GFR) and serum triglycerides and total cholesterol and also that, at 12-months posttransplant, total cholesterol was an independent risk factor for mortality [17][18][19] , but there are few data on the pediatric population after kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric kidney transplant and cardiometabolic risk: a cohort study

et al. 2022

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Introduction: Patients with chronic kidney disease (CKD) are known to have increased cardiovascular risk but there are few data on the risk of pediatric kidney transplant recipients. We aimed to assess the impact of pre- and post-transplant overweight on allograft function and to characterize the evolution of several cardiovascular risk variables over time and their impact. Methods: A retrospective analysis of the records of 23 children/adolescents followed at a tertiary center after kidney transplant was conducted. Data on anthropometry and cardiometabolic variables were analyzed before transplant, six and 12 months after the transplant, and at the last follow-up visit. The impact of the variables on allograft function (glomerular filtration rate (GFR)) was estimated by creatinine-based revised Schwartz formula (Cr-eGFR) and was evaluated using nonparametric tests. Results: The 23 patients included in the study had a median age of 6.3 (4.4-10.1) years. Both systolic and diastolic BP z-score values significantly decreased between BMI groups [1.2 (-0.2 - 2.3) vs. 0.3 (-0.4 - 0.6), p=0.027 and 0.8 (-0.4 - 1.3) vs. 0.1 (-0.6 - 0.7), p=0.028, pre-transplant and at the final evaluation, respectively]. During follow-up, GFR values decreased (Cr-GFR: 68.9 (57.7-76.8) vs. 58.6 (48.9-72.9), p=0.033 at 6-months and at the end, respectively). Significant negative correlations between triglycerides and cystatin C-based eGFR (ρ=-0.47, p=0.028) and Cr-Cys-eGFR (ρ=-0.45, p=0.043) at the end of the study were found. Conclusion: Our study showed a high number of overweight children undergoing kidney transplant. A negative correlation between triglycerides and GFR was found, which highlights the importance of managing nutritional status and regular blood lipids evaluation after kidney transplant.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Pediatric kidney transplant and cardiometabolic risk: a cohort study

et al. 2022

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“…However, the mechanism is not well understood. 18 The main benefit of the management of lipids is to reduce atherosclerosis risk. Atherosclerosis starts earlier in childhood, with 50% of children 10-14 years old having fatty streaks and 8%…”

Section: Ard I Ova Scul Ar D Is E a S E (C Vd) In Adole Scent Ckdmentioning

confidence: 99%

Challenges and unique considerations of adolescents with chronic kidney disease

et al. 2023

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Chronic kidney disease (CKD) is defined by decreased renal function over time. It can be a progressive condition resulting in endstage renal disease (ESRD). Most research into CKD is based on adult populations. Information on the adolescent population is lacking.Adolescents with CKD are a unique subset of patients with a disease that extends through and beyond traditional paediatric age boundaries into adulthood.Given that this is a crucial time of growth and development, the potential disruption by any disease process can be substantially detrimental to a patient. Since the turn of the century, the incidence rate of ESRD has increased to nearly 25 per million. There are many differences in the clinical manifestation, treatment and progression of CKD among adults compared to adolescents, leading to a potential disruption in care. Thus, further information is required to improve the diagnosis, treatment and prevention of the progression of CKD in adolescents. Given the propensity to lose follow-up during the transition between adolescent and adult care, it can be difficult to conduct long-term follow-up studies on patients. In order to rectify this issue, we look to consolidate available data on adolescent CKD to advance our current knowledge. This review will surmise the different aspects of adolescent CKD, including definition, epidemiology, pathophysiology, cardiovascular manifestations, neurocognitive

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“…A recently published review by Bock et al proposed a comprehensive approach to screening and management of dyslipidemia in pediatric kidney transplant recipients 121 . The proposed algorithm takes into account the recommendations of the different guidelines, adopting the more frequent monitoring recommendations from the KDIGO guidelines and pairing with the treatment recommendations of the AHA guidelines.…”

Section: Dyslipidemiamentioning

confidence: 99%

“…Once these are addressed and TLC have been implemented, persistent dyslipidemia can be managed with a variety of medications, many of which may be less familiar to pediatric clinicians and are presented in detail below. A brief overview of the most common classes of medications to treat dyslipidemia will be presented, as a very comprehensive review was recently published 121 …”

Section: Dyslipidemiamentioning

confidence: 99%

Promoting cardiovascular health post‐transplant through early diagnosis and adequate management of hypertension and dyslipidemia

Charnaya

Seifert

2020

Pediatric Transplantation

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Despite correction of underlying solid organ failure by transplantation, pediatric transplant recipients still have increased mortality rates compared to the general pediatric population, in part due to increased cardiovascular risk. In particular, pediatric kidney and non‐kidney transplant recipients with chronic kidney disease have significant cardiovascular risk that worsens with declining kidney function. Biomarkers associated with future cardiovascular risk such as casual and ambulatory hypertension, dyslipidemia, vascular stiffness and calcification, and left ventricular hypertrophy can be detected throughout the post‐transplant period and in patients with stable kidney function. Among these, hypertension and dyslipidemia are two potentially modifiable cardiovascular risk factors that are highly prevalent in kidney and non‐kidney pediatric transplant recipients. Standardized approaches to appropriate BP measurement and lipid monitoring are needed to detect and address these risk factors in a timely fashion. To achieve sustained improvement in cardiovascular health, clinicians should partner with patients and their caregivers to address these and other risk factors with a combined approach that integrates pharmacologic with non‐pharmacologic approaches. This review outlines the scope and impact of hypertension and dyslipidemia in pediatric transplant recipients, with a particular focus on pediatric kidney transplantation given the high burden of chronic kidney disease‐associated cardiovascular risk. We also review the current published guidelines for monitoring and managing abnormalities in blood pressure and lipids, highlighting the important role of therapeutic lifestyle changes in concert with antihypertensive and lipid‐lowering medications.

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Management of dyslipidemia in pediatric renal transplant recipients

Cited by 11 publications

References 72 publications

Pediatric kidney transplant and cardiometabolic risk: a cohort study

Pediatric kidney transplant and cardiometabolic risk: a cohort study

Challenges and unique considerations of adolescents with chronic kidney disease

Promoting cardiovascular health post‐transplant through early diagnosis and adequate management of hypertension and dyslipidemia

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