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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Carotid intima-media thickness in children with end-stage renal disease on dialysis
A Gheissari1, M Sirous, T Hajzargarbashi
1Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Cardiovascular issues are prevalent in children with end-stage renal disease (ESRD). Intima-media thickness (IMT-C) is a potential early marker for atherosclerosis, correlating with N-PTH and alkaline phosphatase levels in these patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Diagnostic Markers
Background:
- Cardiovascular disease is a leading cause of mortality in end-stage renal disease (ESRD) patients.
- Limited data exists on early atherosclerosis markers like intima-media thickness (IMT) in pediatric ESRD patients undergoing dialysis.
- This study investigates carotid (IMT-C) and bulb (IMT-B) intima-media thickness in children on hemodialysis (HD) and peritoneal dialysis (PD).
Purpose of the Study:
- To assess carotid and bulb intima-media thickness (IMT-C and IMT-B) as early atherosclerosis markers in pediatric ESRD patients.
- To identify factors associated with IMT in children on hemodialysis (HD) and peritoneal dialysis (PD).
- To compare IMT measurements between HD and PD pediatric patients.
Main Methods:
- Retrospective analysis of 16 pediatric ESRD patients (<18 years) on HD (n=9) and PD (n=7).
- Biochemical markers including serum von Willebrand factor (vWF), homocysteine, apo lipoproteins A and B, and C-reactive protein (CRP) were measured.
- Carotid (IMT-C) and bulb (IMT-B) intima-media thickness were measured using ultrasound.
Main Results:
- Significant differences in cholesterol, triglycerides, apo A, apo B, CRP, vWF, homocysteine, and IMT-C were observed in ESRD patients.
- Mean systolic blood pressure was significantly higher in the HD group compared to the PD group.
- Partial correlation, adjusted for age, revealed significant associations between IMT-C and N-PTH and serum alkaline phosphatase.
Conclusions:
- Intima-media thickness, particularly IMT-C, shows alterations in pediatric ESRD patients and correlates with specific biochemical markers.
- Further longitudinal studies with larger sample sizes are necessary to elucidate the contributing factors to intima-media thickness in pediatric ESRD.
- IMT-C may serve as a valuable early indicator of atherosclerosis in children with end-stage renal disease.
Abstract:
Cardiovascular morbidity and mortality are common in end stage renal disease (ESRD) patients. There is scarce data on carotid and bulb intima-media thickness (IMT-C and IMT-B) as an early marker of atherosclerosis and related factors in children on hemodialysis (HD) and peritoneal dialysis (PD). Since we did not have enough information about our patients, this study was carried on all ESRD children (hemodialysis and peritoneal dialysis) in a referral center. Data was collected from 16 ESRD children under 18 years with seven patients on PD and nine on HD. Lab tests and biochemical parameters including serum von Willebrand factor (vWF), homocystein, apo lipoprotein A, apo lipoprotein B and quantitative CRP were measured in fasting patients just before initiating dialysis. IMT-C and IMT-B were measured by gray scale ultrasound using 7.5 MHZ probe. The mean of age was 12.76+/-4.5 years. The mean duration of dialysis in HD and PD patients were not significantly different; 11.88+/-3.25 months and 10.14+/-2.4 months respectively. Mean of systolic blood pressure in HD group was significantly higher than PD group, 135.55+/-25.54 mmHg versus 121.42+/-12.14 mmHg, P<0.05. Significant differences among all following parameters in ESRD patients, with normal laboratory values, were clarified: cholesterol, triglycerides, apo A, apo B, quantitative CRP, VWF, homocystein and IMT-C. However, we could not demonstrate any difference between IMT-B in case and control group. After adjusting for age, partial correlation showed significant correlation between IMT-C and following factors: N-PTH and serum alkaline phosphatase. Longitudinal studies with large size samples are needed to clarify the contributing factors with intima-media thickness in ESRD children.
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