The burden of subclinical cardiovascular disease in children and young adults with chronic kidney disease and on dialysis

Abstract

Introduction Cardiovascular disease (CVD) is a common cause of morbidity and mortality even in young people with chronic kidney disease (CKD). We examined structural and functional cardiovascular changes in patients with CKD stages 4-5 and on dialysis under 30 years of age. Methods 79 children and 21 young adults underwent cardiac CT for coronary artery calcification (CAC), ultrasound for carotid intima media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV), and echocardiography. Differences in structural [CAC, cIMT z-score, left ventricular mass index] and functional [carotid distensibility z-score, cfPWV z-score] measures were examined between CKD stages 4-5 and dialysis patients. Results Overall the cIMT z-score was raised (median 2.17, IQR 1.14-2.86) and 10 (10%) had CAC. 16/23(69.5%) of CKD4-5 and 68/77(88.3%) on dialysis had at least one structural or functional CV abnormality. There was no difference in the prevalence of structural abnormalities in CKD or dialysis cohorts, but functional abnormalities were more prevalent in patients on dialysis (p < 0.05). The presence of > 1 structural abnormality was associated with a 4.5-fold increased odds of > 1 functional abnormality (95% CI 1.3 to 16.6, p < 0.05). Patients with structural and functional abnormalities (cIMT z-score >2SD or distensibility <-2SD) had less carotid dilatation (lumen/wall cross sectional areas ratio) compared to those with normal cIMT and distensibility. Conclusion There is a high burden of subclinical cardiovascular disease in young CKD patients, with a greater prevalence of functional abnormalities in dialysis compared to CKD patients. Longitudinal studies are required to test these hypothesis generating data and define the trajectory of CV changes in CKD.

Bone Mineral Density and Vascular Calcification in Children and Young Adults With CKD 4 to 5 or on Dialysis

“…Demographics of the study population (that completed follow-up, n = 57) at baseline are shown in Table 1 . The baseline characteristics of the whole cohort ( N = 100) and their bone and vascular measures have been published 11 , 12 and are summarized in Supplementary Tables S1 and S2 . Fifty-seven patients were followed up after a median of 1.45 (1.25, 1.81) years.…”

“…A total of 100 children and young adults with CKD entered the study, and 57 were followed up after a median of 1.45 (1.25, 1.81) years. Cross-sectional data on bone health 11 and subclinical cardiovascular disease 12 in this cohort have been published ( N = 100). All further analyses described pertain to the 57 participants who were followed up.…”

“…These included serum ionized Ca, total Ca, phosphate, magnesium, bicarbonate, intact parathyroid hormone, 25-hydroxyvitamin D, and alkaline phosphatase (ALP). All imaging protocols have been published 11 , 12 and are described in detail in the Supplementary Material together with details of the biomarker analysis.…”

“…cIMTz and PWVz for young adults aged from 18 to 30 years were calculated using interpolation of the difference between 17 and 18 years in the reference data set, 14 , 15 as published previously. 12 …”

Cardiovascular changes in young renal failure patients

“…Lalayiannis et al present in this issue of Clinical Kidney Journal significant evidence of subclinical cardiovascular disease in a young renal failure cohort [ 4 ]. The findings are based on thorough cardiovascular examination of 100 young kidney failure patients (chronic kidney disease stages 4 and 5) including patients on dialysis.…”