Dyslipidemia worsens as GFR declines, BMI increases in children with CKD
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Researchers of a published study observed a worsening of dyslipidemia in proportion to declining GFR, worsening proteinuria and increasing BMI in children with chronic kidney disease.
“Dyslipidemia is a well-recognized atherosclerotic cardiovascular disease risk factor found commonly in children and adults with CKD,” Jeffrey M. Saland, MD, chief of the division of pediatric nephrology and hypertension at the Mount Sinai Kravis Children’s Hospital, and colleagues wrote. “ ... However, there are no studies that have prospectively followed individuals, child or adult, with CKD over many years to verify if progression of CKD is associated with progression of dyslipidemia, the magnitude of the link, and which specific elements of CKD associate with specific lipid measures.”
Using data from the CKD in Children study, researchers followed 508 children with non-glomerular (76%) or glomerular CKD (24%) for a median of 4 years. Primary outcomes of the study were changes in fasting lipid levels (all patients were required to have two to six lipid measurements), including total cholesterol, HDL cholesterol, non-HDL cholesterol and triglycerides. Risk factors — such as change from baseline GFR, proteinuria and BMI — were also considered.
Noting that 35% of children with non-glomerular CKD and 43% of children with glomerular CKD had dyslipidemia at baseline, researchers found the condition persisted as the children aged. Longitudinal increases in proteinuria were independently associated with increases in non-HDL cholesterol (non-glomerular: 4.9 mg/dL; glomerular: 8.5 mg/dL) and triglycerides (non-glomerular: 3%; glomerular: 5%), while decreases in GFR during follow-up were associated with decreases of HDL cholesterol in children with non-glomerular CKD (-1.2 mg/dL) and increases of non-HDL cholesterol in those with glomerular CKD (3.9 mg/dL). Researchers further observed that increasing BMI was associated with multiple lipid changes over time.
“Our results strengthen the concept that slowing CKD progression and preventing obesity should slow the development of dyslipidemia and, subsequently, cardiovascular disease,” the researchers wrote. “Moreover, in studying the effect of CKD on development of dyslipidemia in children, there was a comparatively low level of confounding. Unlike adults with CKD, most children have primary causes of CKD and do not commonly present with competing causes of dyslipidemia other than obesity (if present). In that respect, our cohort allows perhaps the best possible model of this pathophysiologic complication of CKD in humans, making our findings generalizable to other populations with CKD.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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