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

Clinic of Pediatrics Vilnius University Vilnius Lithuania

Cukurova Universitesi Adana Turkey

Department of Nephrology and Arterial Hypertension The Children's Memorial Health Institute Warsaw Poland

Department of Nephrology Hannover Medical School Hannover Germany

Department of Pediatric Kidney Liver and Metabolic Diseases Hannover Medical School Hannover Germany

Department of Pediatrics and Adolescent Medicine Vienna Austria

Division of Nephrology and Dialysis Bambino Gesù Children's Hospital IRCCS Rome Italy

Division of Pediatric Cardiology Department of Pediatrics Trakya University School of Medicine Edirne Turkey

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 Department of Pediatrics Ankara University Faculty of Medicine Ankara Turkey

Division of Pediatric Nephrology Hacettepe University Faculty of Medicine Ankara Turkey

Ege University Izmir Turkey

Institute of Medical Biometry and Informatics University of Heidelberg Heidelberg Germany

Integrated Research and Treatment Center Transplantation Hannover Medical School Hannover 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

University Hospital Motol Prague Czech Republic

Citace poskytuje Crossref.org

Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry