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Updated: Jun 18, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
A comprehensive study of cardiovascular risk factors, cardiac function and vascular disease in children with chronic
Choni Rinat1, Rachel Becker-Cohen, Amiram Nir
1Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel. chrinat@szmc.org.il
Insights
Children with chronic kidney disease (CKD) show early signs of cardiovascular disease. Non-traditional risk factors like uric acid and homocysteine are key, highlighting the need for preventative strategies in this vulnerable pediatric population.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Clinical Medicine
Background:
- Cardiovascular disease (CVD) significantly impacts morbidity and mortality in pediatric chronic kidney disease (CKD).
- CVD in CKD involves atherosclerosis, medial vascular calcifications, and myocardial disease.
- Children with CKD offer a unique model to study kidney disease's role in CVD development, as atherosclerosis is less prevalent.
Purpose of the Study:
- To investigate cardiovascular disease risk factors and manifestations in pediatric patients with chronic kidney disease stages 3-5.
- To assess the relationship between CKD progression and both traditional and non-traditional cardiovascular risk factors.
- To evaluate vascular and myocardial structure and function in relation to specific clinical and laboratory variables.
Main Methods:
- Seventy patients (4 months to 18 years) with CKD stages 3-5 were evaluated.
- Carotid artery ultrasound assessed vascular structure and function.
- Echocardiography evaluated myocardial disease; laboratory tests assessed risk factors.
Main Results:
- Traditional cardiovascular risk factors did not correlate with CKD progression.
- Non-traditional risk factors, including elevated uric acid and homocysteine, increased with CKD stage.
- Left ventricular hypertrophy and diastolic dysfunction were the primary myocardial abnormalities; vascular function correlated with calcium-phosphate metabolism.
Conclusions:
- Pediatric CKD patients exhibit early cardiovascular disease risk factors and signs.
- Uric acid and homocysteine may play significant roles in pediatric CKD-related cardiovascular disease.
- Further research is needed to develop interventions preventing cardiovascular morbidity and mortality in this high-risk group.
Background:
Cardiovascular disease causes major morbidity and is an important determinant of premature death in the paediatric chronic kidney disease (CKD) population. It is composed of three separate, although interrelated, disease processes: atherosclerosis, arteriosclerosis (i.e. medial vascular calcifications) and myocardial disease. Myocardial consequences of atherosclerosis barely exist in children, thus providing a good opportunity to investigate the role that kidney disease plays in the development of cardiovascular disease.
Methods:
We assessed 70 patients, aged 4 months to 18 years, with chronic kidney disease stages 3-5, for known risk factors of cardiovascular disease and for additional laboratory and clinical variables which may have an impact on this disease process. Carotid artery ultrasound was used to evaluate vascular structure and function, whereas myocardial disease was assessed by echocardiography.
Results:
Traditional risk factors, although present in this cohort, did not accumulate with progression of chronic kidney disease. Non-traditional risk factors increased in number and severity in correlation with the stage of CKD. The main myocardial abnormalities were left ventricular hypertrophy and diastolic dysfunction. Vascular function tests correlated with calcium-phosphate metabolism variables, homocysteine and time-averaged serum uric acid.
Conclusions:
This study shows that children with CKD are exposed to risk factors and demonstrate signs of cardiovascular disease already at a young age. The possible role of uric acid and homocysteine in the evolution of cardiovascular disease is discussed. Further studies looking at possible interventions to prevent cardiovascular morbidity and mortality in this high risk population are needed.
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