Cardiovascular Disease Risk Factors and Left Ventricular Hypertrophy in Girls and Boys With CKD
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Published on: November 7, 2017
Rebecca L Ruebner1, Derek Ng2, Mark Mitsnefes3
1Division of Nephrology, Department of Pediatrics, and.
Insights
Children with chronic kidney disease (CKD) show no sex differences in left ventricular mass when adjusted for lean body mass. Indexing left ventricular mass to lean body mass may be a better method for assessing heart conditions in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Chronic Illness
- Sex Differences in Disease
Background:
- Previous research indicates women with chronic kidney disease (CKD) face higher risks of cardiovascular disease (CVD) and mortality than men.
- The underlying biological mechanisms for these observed sex disparities in CKD patients remain unclear.
- This study investigates sex-based differences in CVD risk factors and left ventricular hypertrophy (LVH) in children with CKD.
Purpose of the Study:
- To assess sex differences in cardiovascular disease (CVD) risk factors and left ventricular hypertrophy (LVH) in children with chronic kidney disease (CKD).
- To examine the relationship between left ventricular mass (LVM) and various body size metrics in pediatric CKD patients.
- To identify potential sex-specific mechanisms contributing to cardiovascular risk in children with CKD.
Main Methods:
- The study analyzed data from 681 children with CKD from the Chronic Kidney Disease in Children cohort.
- Cardiovascular disease risk factors were compared between sexes. Left ventricular hypertrophy (LVH) was defined using two methods: LVM indexed to height (LVM/height^2.7) and LVM indexed to estimated lean body mass (eLBM).
- Multivariate regression models were used to assess sex differences in LVM after adjusting for age, weight, height, and eLBM.
Main Results:
- Girls exhibited lower rates of uncontrolled hypertension and high triglycerides compared to boys.
- LVH prevalence was higher in girls when indexed to height, but similar between sexes when indexed to eLBM.
- After adjusting for eLBM, regression analyses revealed no significant sex differences in left ventricular mass (LVM).
Conclusions:
- While height-indexed LVM suggests higher LVH in girls, eLBM-indexed LVM shows no sex differences in pediatric CKD.
- The findings suggest that indexing LVM to eLBM may offer a more accurate assessment of cardiac remodeling in children with CKD.
- Further research is needed to elucidate the mechanisms behind sex differences in cardiovascular risk in pediatric CKD.
Background And Objectives:
Prior studies suggested that women with CKD have higher risk for cardiovascular disease (CVD) and mortality than men, although putative mechanisms for this higher risk have not been identified. We assessed sex differences in (1) CVD risk factors and left ventricular hypertrophy (LVH), and (2) the relationship of left ventricular mass (LVM) with different measures of body size in children with CKD.
Design, Setting, Participants, And Measurements:
The study population comprised 681 children with CKD from the Chronic Kidney Disease in Children cohort, contributing 1330 visits. CVD risk factors were compared cross-sectionally by sex. LVH was defined as LVM/height2.7 >95th percentile and LVM relative to estimated lean body mass (eLBM) >95th percentile for age and sex. Differences in LVM by sex were assessed by adjusting for age, weight, height, and eLBM using bivariate and multivariate regression models.
Results:
Girls were less likely to have uncontrolled hypertension (26% versus 38%, P=0.001), had lower diastolic BP z-scores (+0.3 versus +0.6, P=0.001), and had lower prevalence of high triglycerides (38% versus 47%, P=0.03) compared with boys. When LVH was defined by LVM indexed to height, girls had higher prevalence of LVH (16% versus 9%, P=0.01); when LVH was defined by LVM relative to eLBM, prevalence of LVH was similar between girls and boys (18% versus 17%, P=0.92). In regression models adjusting for eLBM, no sex differences in LVM were observed.
Conclusions:
Despite lack of increased prevalence of CVD risk factors, indexing LVM to height showed a higher proportion of LVH among girls, while estimates of LVH based on eLBM showed no sex differences. Indexing LVM to eLBM may be an alternative to height indexing in children with CKD.
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