Cardiovascular risk assessment in children with chronic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Vascular Biology

Background:

• Chronic kidney disease (CKD) is a significant contributor to cardiovascular (CV) morbidity and mortality, particularly in patients undergoing dialysis.
• Accurate estimation of CV risk is crucial for identifying modifiable factors and evaluating treatment efficacy in CKD patients.

Purpose of the Study:

• To review current non-invasive methods for assessing cardiovascular damage in CKD patients.
• To discuss the applicability and limitations of these methods, especially in pediatric populations.
• To provide recommendations for risk management in early CKD stages.

Main Methods:

• Review of non-invasive techniques for measuring structural vascular changes (e.g., carotid intima-media thickness, coronary artery calcification).
• Assessment of functional vascular changes (e.g., pulse wave velocity, ambulatory blood pressure monitoring, heart rate variability).
• Evaluation of circulating biomarkers indicative of vascular damage and progression.

Main Results:

• Multiple non-invasive methods and biomarkers exist to assess vascular damage and predict CV events in adult CKD patients.
• These methods require technical adaptation, standardization, and validation for reliable use in children.
• Current evidence suggests these advanced tests are best suited for research in pediatric CKD.

Conclusions:

• Focusing on modifiable risk factors for calcification from early stages of CKD is a more effective use of limited clinical resources.
• Preventative strategies targeting risk factor reduction are paramount for managing CV risk in pediatric CKD.
• Further research is needed to validate existing and develop new non-invasive tools for pediatric cardiovascular risk assessment.