NDT Advance Access published online on March 14, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn083
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Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease
1 Department of Nephrology, The Children's Memorial Health Institute, Warsaw, Poland 2 Division of Paediatric Nephrology 3 Department of Paediatric Radiology, Hospital for Paediatric and Adolescent Medicine, University of Heidelberg, Germany 4 Department of Radiology, The Children's Memorial Health Institute, Warsaw, Poland
Correspondence and offprint requests to: Mieczyslaw Litwin, Department of Nephrology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04–730 Warsaw, Poland. Email: m.litwin{at}czd.pl
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Abstract |
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This observational study was designed to verify the hypothesis that the treatment modality significantly affects the evolution of CKD-associated arteriopathy.
Patients. Paediatric patients (mean age 13.8 ± 4.2 years) with chronic kidney disease (CKD) stages 3–5, including 24 patients with mean GFR 54 ± 21 ml/min/1.73 m2 (CKD group) and 32 patients in end-stage renal disease, of whom 19 received a renal allograft (D-Rtx) and 13 remained on dialysis (D-D).
Methods. Sonography of the common carotid artery was performed at baseline and after 12 months. Intima-media thickness (IMT) and the cross-sectional areas of the vessel wall (WCSA) and lumen (LCSA) were measured and normalized to age (SDS).
Results. At baseline IMT-SDS and WCSA-SDS were increased above normal, and were significantly higher in D than in CKD patients (P < 0.001). IMT-SDS increased over time in CKD and D-D patients (1.4 ± 1.7 to 2.1 ± 1.2, P = 0.05). In contrast, IMT-SDS (2.8 ± 0.6 to 2.0 ± 0.6, P < 0.005) decreased in those D-Rtx patients who had elevated values prior to transplantation. The total number of patients with elevated cIMT-SDS changed from 7 to 13 in the 24 CKD, from 8 to 11 in the 13 D-D and from 11 to 12 in the 19 D-Rtx patients. While IMT-SDS was independently correlated with blood pressure and serum phosphate in the CKD and D patients, only total dialysis vintage (r = 0.50; P < 0.05) and the IMT-SDS attained at the time of grafting (r = 0.46, P < 0.05) correlated with IMT-SDS 1 year post-Rtx.
Conclusion. While vascular lesions rapidly progress in CKD and D patients, abolition of the uraemic state by Rtx leads to stabilization or partial regression of CKD-associated arteriopathy. Cumulative dialysis duration and the degree of arterial damage prevalent at the time of grafting are the main determinants of persistent arteriopathy 1 year after Rtx.
Keywords: atherosclerosis; chronic kidney disease; hypertension; paediatrics; risk factors
Received for publication: 16. 4.07
Accepted in revised form: 29. 1.08
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