Children with CKD experience increased arterial stiffness
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Children aged 6 to 17 years with chronic kidney disease experience increased arterial stiffness, as measured by pulse wave velocity, but it is not a factor that correlates with eGFR or disease progression.
“Studies in children with CKD have thus far reported conflicting evidence about the prevalence of arterial stiffening. A range of risk factors was suggested to contribute to arterial stiffening during childhood, but a comprehensive description of the risk profile and association with CKD progression in children is lacking,” Karolis Azukaitis, MD, PhD, from Vilnius University Hospital Santariki Klinikosand in Lithuania, and colleagues wrote. “The primary aim of our analysis was to investigate the evolution and risk factors for arterial stiffening by measuring pulse wave velocity (PWV) in a large prospective cohort of children with pre-dialysis CKD.”
Researchers evaluated 667 patients aged 6 to 17 years with CKD stages 3 to 5 from the Cardiovascular Comorbidity in Children with CKD (4C) study. Patients were followed with 6-month visits and underwent measurements of PWV every 12 months.
Researchers conducted linear regression analysis to determine the correlation of variables with PWV at baseline. Similarly, researchers used multivariable linear mixed-effects models with time as the fixed effect and patient-individual random intercepts and slopes to assess the association of time-dependent explanatory variables with the outcomes of interest (absolute PWV and PWVz).
Analyses revealed 20% of patients showed a PWV above the 95th percentile at baseline. During the median follow-up of 2.7 years, absolute PWV increased, while PWV z score remained consistent. Researchers identified a correlation between absolute PWV and 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 in addition to higher diastolic blood pressure z score, lower height z score, younger age and girls.
During a median follow-up of 2.4 years, 369 of 628 patients reached the composite point of CKD progression.
Ultimately, PWV z score did not correlate with CKD progression by univariable or multivariable proportional hazard analyses corrected for the established predictors of eGFR, proteinuria and blood pressure.
Researchers noted that a limitation of the study was the lack of a prospective control cohort.
“In summary, we have shown increased PWV in approximately one-fifth of children with advanced CKD that is not related to kidney function changes over time. The identification of modifiable risk factors, such as higher diastolic BP, lower vitamin D levels, proteinuria, and higher LDL cholesterol, suggests added benefits of their control in childhood CKD and prompts further evaluation of PWV in interventional studies," Azukaitis and colleagues wrote. "The potential protective properties of ferritin to the arterial tree necessitate additional clinical and mechanistic studies. Although PWV does not associate with the risk of CKD progression in childhood, further studies investigating the effects of early arterial stiffening on cardiovascular outcomes are needed.”
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