Bernhard M W Schmidt1,2, Rizky Indrameikha Sugianto2,3, Daniela Thurn2,3,4, Karolis Azukaitis5,6, Aysun K Bayazit7, Nur Canpolat8, Ayse Guler Eroglu8, Salim Caliskan8, Anke Doyon5, Ali Duzova9, Tevfik Karagoz10, Ali Anarat7, Murat Deveci11,12, Sevgi Mir11, Bruno Ranchin13, Rukshana Shroff14, Esra Baskin15, Mieczyslaw Litwin16, Z Birsin Özcakar17, Rainer Büscher18, Oguz Soylemezoglu19, Jiri Dusek20, Markus J Kemper21, Maria C Matteucci22, Sandra Habbig23, Guido Laube24, Elke Wühl5, Uwe Querfeld25, Anja Sander26, Franz Schaefer5, Anette Melk2,3. 1. Department of Nephrology, Hannover Medical School, Hannover, Germany. 2. Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany. 3. Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany. 4. Department of Pediatrics and Adolescent Medicine, Vienna, Austria. 5. Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany. 6. Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania. 7. Cukurova Universitesi, Adana, Turkey. 8. Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey. 9. Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey. 10. Division of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey. 11. Ege University, Izmir, Turkey. 12. Division of Pediatric Cardiology, Department of Pediatrics, Trakya University School of Medicine, Edirne, Turkey. 13. Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 14. Renal Unit, Great Ormond Street Hospital for Children, London, United Kingdom. 15. Division of Pediatric Nephrology, Baskent University Faculty of Medicine, Ankara Turkey. 16. Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland. 17. Division of Pediatric Nephrology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey. 18. University Children's Hospital, Essen, Germany. 19. Children's Hospital, Gazi University, Ankara, Turkey. 20. University Hospital Motol, Prague, Czech Republic. 21. University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany. 22. Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital, IRCCS, Rome Italy. 23. University Children's Hospital, Cologne, Germany. 24. Nephrology Department, University Children's Hospital Zurich, Switzerland. 25. Clinic of Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany. 26. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND: The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. METHODS: We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). RESULTS: RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ß = -0.67; P < 0.001) and intima media thickness (ß = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ß = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ß = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ß = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ß = 1.47; P = 0.01). CONCLUSIONS: In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.
BACKGROUND: The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. METHODS: We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). RESULTS: RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ß = -0.67; P < 0.001) and intima media thickness (ß = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ß = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ß = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ß = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ß = 1.47; P = 0.01). CONCLUSIONS: In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.
Authors: Rizky I Sugianto; Bernhard M W Schmidt; Nima Memaran; Ali Duzova; Rezan Topaloglu; Tomas Seeman; Sabine König; Luca Dello Strologo; Luisa Murer; Zeynep Birsin Özçakar; Martin Bald; Mohan Shenoy; Anja Buescher; Peter F Hoyer; Michael Pohl; Heiko Billing; Jun Oh; Hagen Staude; Martin Pohl; Gurkan Genc; Günter Klaus; Caner Alparslan; Ryszard Grenda; Jacek Rubik; Kai Krupka; Burkhard Tönshoff; Elke Wühl; Anette Melk Journal: Pediatr Nephrol Date: 2019-12-07 Impact factor: 3.714
Authors: Rizky Indrameikha Sugianto; Karen Ostendorf; Nima Memaran; Anette Melk; Elena Bauer; Jeannine von der Born; Jun Oh; Markus J Kemper; Rainer Buescher; Bernhard M W Schmidt Journal: Pediatr Nephrol Date: 2022-09-12 Impact factor: 3.651