Carotid intima-media thickness in children with CKD: results from the CKiD study
Tammy M Brady1, Michael F Schneider, Joseph T Flynn
1Department of Pediatrics, Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD 21287, USA. tbrady8@jhmi.edu
Insights
Children with chronic kidney disease (CKD) have increased carotid intima-media thickness (cIMT), a marker of cardiovascular risk. Hypertension and dyslipidemia are significantly associated with this increased cIMT in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Biomedical Ultrasound
Background:
- Increased carotid intima-media thickness (cIMT) predicts cardiovascular events in adults.
- Children with chronic kidney disease (CKD) face elevated cardiovascular risk.
- Identifying cardiovascular risk factors in pediatric CKD is crucial.
Purpose of the Study:
- To identify cardiovascular risk factors associated with increased cIMT in children with CKD.
- To compare cIMT in children with CKD to healthy controls.
- To assess the impact of various factors on cIMT in pediatric CKD.
Main Methods:
- Cross-sectional analysis of 101 children (aged 2-18) with mild to moderate CKD.
- Comparison with 97 healthy pediatric controls.
- cIMT measured using standardized B-mode ultrasound after 12 months of follow-up.
Main Results:
- Children with CKD exhibited significantly higher median cIMT (0.43 mm) than healthy controls (0.41 mm).
- Multivariable analysis revealed dyslipidemia and hypertension were associated with greater mean cIMT.
- Factors like BMI, GFR, and birth weight were not significantly associated with cIMT.
Conclusions:
- cIMT is significantly elevated in children with CKD, indicating heightened cardiovascular risk.
- Hypertension and dyslipidemia are key risk factors associated with increased cIMT in this population.
- Early identification and management of these risk factors are essential for pediatric CKD patients.
Background And Objectives:
In adults, increased carotid intima-media thickness (cIMT) as assessed by ultrasonography is a valid predictor of cardiovascular events. Children with CKD are known to be at increased cardiovascular risk. This study sought to identify cardiovascular risk factors associated with increased cIMT in children with CKD.
Design, Setting, Participants, & Measurements:
This was a cross-sectional analysis of cIMT obtained after 12 months of follow-up of 101 children aged 2-18 years with mild to moderate CKD (median GFR 42.9 ml/min per 1.73 m(2)) in the Chronic Kidney Disease in Children cohort study enrolled between April 2005 and September 2009 and 97 healthy pediatric controls between January 2003 and December 2008. An average of six standardized B-mode ultrasound measurements constituted the overall cIMT measurement.
Results:
The median cIMT was 0.43 mm (interquartile range, 0.38-0.48) compared with 0.41 mm in healthy controls (P=0.03 for difference). After multivariable adjustment, the median cIMT was 0.02 mm (95% confidence interval [CI], 0.01-0.05) larger than that of the healthy controls. In a multivariable linear regression analysis, dyslipidemia and hypertension were associated with 0.05 mm (95% CI, 0.01-0.08) and 0.04 mm (95% CI, 0.003-0.08) greater mean cIMT, respectively. Body mass index, CKD etiology, GFR, birth weight, pubertal status, calcium, phosphorus, sex, and race were not associated with cIMT.
Conclusions:
cIMT is significantly elevated among children with CKD, as is the prevalence of other cardiovascular risk factors. Of these risk factors, hypertension and dyslipidemia are significantly associated with increased cIMT.
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