Karolis Azukaitis1, Marietta Kirchner2, Anke Doyon3, Mieczysław Litwin4, Aysun Bayazit5, Ali Duzova6, Nur Canpolat7, Augustina Jankauskiene8, Rukshana Shroff9, Anette Melk10, Uwe Querfeld11, Franz Schaefer. 1. Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania k.azukaitis@gmail.com. 2. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany. 3. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany. 4. Department of Nephrology and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland. 5. Department of Pediatric Nephrology, Cukurova University, Adana, Turkey. 6. Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. 7. Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey. 8. Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 9. Renal Unit, University College London Great Ormond Street Institute of Child Health, London, United Kingdom. 10. Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany. 11. Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract
BACKGROUND AND OBJECTIVES: CKD has been linked to increased arterial stiffness in adults, but data in children with CKD remain conflicting. We aimed to investigate the longitudinal dynamics and determinants of pulse wave velocity in children with CKD and its association with CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed an analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study, which prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the time of KRT initiation. Two separate analyses were performed: with absolute pulse wave velocity (primary outcome) and with pulse wave velocity standardized to height (z score; restricted to participants ≤17 years) as a sensitivity analysis. RESULTS: In total, 667 patients with a mean baseline eGFR of 27 ml/min per 1.73 m2 were included. Pulse wave velocity above the 95th percentile was observed in 124 (20%) patients at baseline. Absolute pulse wave velocity increased gradually over the median follow-up of 2.7 (interquartile range, 0.7-4.4) years, whereas pulse wave velocity z score remained relatively stable. Absolute pulse wave velocity over time associated with time; older age; higher mean arterial pressure, LDL cholesterol, and albuminuria; and lower ferritin. Pulse wave velocity z score (n=628) was associated with the same variables and additionally, with higher diastolic BP z score, lower height z score, younger age, and girls. Of 628 patients, 369 reached the composite end point of CKD progression (50% eGFR loss, eGFR <10 ml/min per 1.73 m2, or the start of KRT) during a median follow-up of 2.4 (interquartile range, 0.9-4.6) years. Pulse wave velocity z score did not associate with CKD progression by univariable or multivariable proportional hazard analysis correcting for the established predictors eGFR, proteinuria, and BP. CONCLUSIONS: Pulse wave velocity is increased in children with CKD but does not associate with eGFR or CKD progression.
BACKGROUND AND OBJECTIVES: CKD has been linked to increased arterial stiffness in adults, but data in children with CKD remain conflicting. We aimed to investigate the longitudinal dynamics and determinants of pulse wave velocity in children with CKD and its association with CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed an analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study, which prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the time of KRT initiation. Two separate analyses were performed: with absolute pulse wave velocity (primary outcome) and with pulse wave velocity standardized to height (z score; restricted to participants ≤17 years) as a sensitivity analysis. RESULTS: In total, 667 patients with a mean baseline eGFR of 27 ml/min per 1.73 m2 were included. Pulse wave velocity above the 95th percentile was observed in 124 (20%) patients at baseline. Absolute pulse wave velocity increased gradually over the median follow-up of 2.7 (interquartile range, 0.7-4.4) years, whereas pulse wave velocity z score remained relatively stable. Absolute pulse wave velocity over time associated with time; older age; higher mean arterial pressure, LDL cholesterol, and albuminuria; and lower ferritin. Pulse wave velocity z score (n=628) was associated with the same variables and additionally, with higher diastolic BP z score, lower height z score, younger age, and girls. Of 628 patients, 369 reached the composite end point of CKD progression (50% eGFR loss, eGFR <10 ml/min per 1.73 m2, or the start of KRT) during a median follow-up of 2.4 (interquartile range, 0.9-4.6) years. Pulse wave velocity z score did not associate with CKD progression by univariable or multivariable proportional hazard analysis correcting for the established predictors eGFR, proteinuria, and BP. CONCLUSIONS: Pulse wave velocity is increased in children with CKD but does not associate with eGFR or CKD progression.
Authors: Łukasz Obrycki; Janusz Feber; Tadeusz Derezinski; Weronika Lewandowska; Zbigniew Kułaga; Mieczysław Litwin Journal: Hypertension Date: 2019-12-30 Impact factor: 10.190
Authors: David T Selewski; Ashton Chen; Ibrahim F Shatat; Priya Pais; Larry A Greenbaum; Pavel Geier; Raoul D Nelson; Stefan G Kiessling; Patrick D Brophy; Alejandro Quiroga; Michael E Seifert; Caroline E Straatmann; John D Mahan; Maria E Ferris; Jonathan P Troost; Debbie S Gipson Journal: Pediatr Nephrol Date: 2015-10-23 Impact factor: 3.714
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