NDT Advance Access originally published online on September 5, 2008
Nephrology Dialysis Transplantation 2009 24(1):309-315; doi:10.1093/ndt/gfn494
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Pulse wave velocity in children following renal transplantation
1 Department of Pediatrics 2 Department of Internal Medicine 3 Transplantation and Surgical Clinic, Semmelweis University 4 Szentágothai János Knowledge Centre, Budapest, Hungary
György S. Reusz, Department of Pediatrics, Semmelweis University, Bókay János u. 53-54, H-1083, Budapest, Hungary. Tel: +36-30-9869545; Fax: +36-1-3138212; E-mail: reusz{at}gyer1.sote.hu
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Abstract |
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Background. Arterial stiffness (ASt) increases with age, a process accelerated by uraemia and reversed by transplantation (Tx). Increased ASt results in an elevated pulse wave velocity (PWV).
Methods. To compare the PWV of Tx patients (n = 25, age = 15.1/95% CI = 13.5–16.7/year) and healthy controls, three control groups were formed: matched for age (A), for height and weight (H/W) and for age and height (A/H), respectively. To avoid bias from the growth deficit of Tx, firstly Z-scores of PWV were calculated (PWV-Z). Second, the PWV/height (PWV/h) ratio was assessed. Pre-Tx serum Ca, P, PTH and the cumulative dose of calcitriol (cCTL) were also analysed. Finally, Tx patients were compared to ESRD patients (n = 11). PWV was measured by applanation tonometry.
Results. Tx were smaller than A and older than H/W. The PWV of Tx differed only from H/W and A/H. PWV-Z and PWV/h of Tx were increased compared to all control groups. They correlated with the CaxP and cCTL before Tx and were independent of age. Patients with creatinine clearance >90 ml/min/1.73 m2 or <1 year on dialysis had lower PWV-Z and PWV/h than ESRD.
Conclusion. Controls that matched for both age and height should be used to assess PWV in children with growth failure. PWV-Z is a universal age-independent parameter of PWV in cases of growth retardation; PWV/h is a simple alternative of PWV-Z. CaxP and cCTL are major determinants of ASt after Tx. PWV may be reduced after Tx suggesting that the uraemia-induced cardiovascular changes might be reversible.
Keywords: arterial stiffness; calcitriol; growth failure; pulse wave velocity; transplantation
* Orsolya Cseprekál and Éva Kis contributed equally to the manuscript.
Received for publication: 5. 2.08
Accepted in revised form: 8. 8.08