Subclinical cardiovascular disease common in children, young adults with kidney disease
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Children and young adults with kidney disease showed a “high burden” of subclinical cardiovascular disease, according to a study that examined structural and functional abnormalities.
The study, which included patients younger than 30 years who had chronic kidney disease stages 4 to 5 or who were receiving dialysis, indicated both groups had a similar prevalence of structural abnormalities but that those on dialysis demonstrated a greater prevalence of functional abnormalities.
Study background
“Vascular damage and calcification may be present early in the course of CKD, and progresses rapidly once dialysis is initiated,” Alexander D. Lalayiannis, MBChB, of the University College London Great Ormond Street Hospital Institute of Child Health, and colleagues wrote. “It has been suggested that structural changes lead to arterial stiffness that in turn, causes an increased left ventricular pressure load and left ventricular hypertrophy (LVH), but correlations between structural and functional vascular changes and factors associated with these changes have not been fully examined.
... This study is part of a longitudinal, multicenter study examining bone and cardiovascular health in children and young adults with CKD. Young adults are included as the skeleton continues to mineralize until the third or fourth decade of life, accruing calcium and perhaps acting as a ‘buffer’ to prevent vascular calcification.”
In a cohort of 79 children and 21 young adults, Lalayiannis and colleagues assessed coronary artery calcification (CAC), carotid intima media thickness (cIMT) and left ventricular mass (serving as structural components), as well as carotid distensibility and arterial stiffness (serving as functional components).
Burden of subclinical cardiovascular disease
In the overall cohort, researchers observed the cIMT z-score was elevated (median was 2.17) and that 10% had CAC.
Findings showed a high prevalence of subclinical cardiovascular abnormalities and changes, with 69.5% of patients with CKD and 88.3% of patients on dialysis having at least one structural or functional abnormality; the presence of one structural abnormality was associated with a 4.5-fold increased odds that a patient would have more than one functional abnormality.
“The prevalence of structural changes including cIMT increase and CAC were comparable in CKD and dialysis cohorts, but indices of arterial stiffness were higher in patients on dialysis, perhaps having developed when compensatory mechanisms such as arterial dilatation are overwhelmed,” the researchers wrote.
Patients with structural and functional abnormalities (cIMT z-score of greater than 2 standard deviations or distensibility less than -2 standard deviations) had less carotid dilatation compared with those who had normal cIMT and distensibility.
“This is the first study in a young CKD cohort, to our knowledge, examining structural and functional CV abnormalities, with a comprehensive panel of surrogate vascular measures including CAC,” Lalayiannis and colleagues wrote. “ ... These data highlight the burden of subclinical [cardiovascular disease] CVD even in a young cohort of CKD 4 [to] 5 and dialysis patients, stressing the importance of preventative strategies to halt the development or attenuate the progression of CVD in CKD.
Also, our study suggests that there may be a temporal association between early structural changes that progress to functional CVD abnormalities when potential compensatory mechanisms, such as carotid dilatation that preserve vessel patency even in the presence of wall thickening, are overwhelmed; these hypothesis generating data will be explored in future longitudinal studies.”
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