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Early Effects of Renal Replacement Therapy on Cardiovascular Comorbidity in Children With End-Stage Kidney Disease: Findings From the 4C-T Study
BMW. Schmidt, RI. Sugianto, D. Thurn, K. Azukaitis, AK. Bayazit, N. Canpolat, AG. Eroglu, S. Caliskan, A. Doyon, A. Duzova, T. Karagoz, A. Anarat, M. Deveci, S. Mir, B. Ranchin, R. Shroff, E. Baskin, M. Litwin, ZB. Özcakar, R. Büscher, O....
Language English Country United States
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Kidney Failure, Chronic complications therapy MeSH
- Child MeSH
- Carotid Intima-Media Thickness MeSH
- Cardiovascular Diseases etiology MeSH
- Comorbidity MeSH
- Humans MeSH
- Adolescent MeSH
- Renal Replacement Therapy * MeSH
- Prospective Studies MeSH
- Blood Flow Velocity MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
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.
Center for Pediatrics and Adolescent Medicine University of Heidelberg Heidelberg Germany
Children's Hospital Gazi University Ankara Turkey
Clinic of Pediatric Nephrology Charité Children's Hospital Berlin Germany
Cukurova Universitesi Adana Turkey
Division of Nephrology and Dialysis Bambino Gesù Children's Hospital IRCCS Rome Italy
Division of Pediatric Cardiology Hacettepe University Faculty of Medicine Ankara Turkey
Division of Pediatric Nephrology Baskent University Faculty of Medicine Ankara Turkey
Division of Pediatric Nephrology Hacettepe University Faculty of Medicine Ankara Turkey
Institute of Medical Biometry and Informatics University of Heidelberg Heidelberg Germany
Istanbul University Cerrahpasa Medical Faculty Istanbul Turkey
Nephrology Department University Children's Hospital Zurich Switzerland
Pediatric Nephrology Unit Hôpital Femme Mère Enfant Hospices Civils de Lyon Lyon France
Renal Unit Great Ormond Street Hospital for Children London United Kingdom
University Children's Hospital Cologne Germany
University Children's Hospital Essen Germany
University Children's Hospital University Medical Center Hamburg Eppendorf Hamburg Germany
References provided by Crossref.org
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- $a Schmidt, Bernhard M W $u Department of Nephrology, Hannover Medical School, Hannover, Germany. Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany.
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