Cardiovascular Phenotypes in Children with CKD: The 4C Study.

Area of Science:

• Pediatric Nephrology
• Cardiovascular Research
• Public Health

Background:

• Cardiovascular disease (CVD) is a critical comorbidity impacting survival in pediatric patients with chronic kidney disease (CKD).
• Early identification and monitoring of cardiovascular risk factors are essential for improving long-term outcomes in this vulnerable population.

Purpose of the Study:

• To investigate the prevalence of subclinical cardiovascular disease markers in children with CKD.
• To explore the association between these markers and clinical factors such as hypertension and CKD stage.

Main Methods:

• A multicenter, prospective, observational study involving 688 children aged 6-17 years with CKD (GFR 10-60 ml/min/1.73 m²).
• Annual monitoring of cardiovascular status using noninvasive surrogate markers: left ventricular mass index, carotid intima-media thickness, and pulse wave velocity.
• Exploratory analysis of variables associated with cardiovascular surrogate markers at baseline.

Main Results:

• A high prevalence of cardiovascular risk factors was observed: 26.1% had uncontrolled hypertension, increasing with CKD stage.
• Left ventricular hypertrophy was present in 10.6% (CKD stage 3a) to 48% (CKD stage 5).
• Elevated carotid intima-media thickness (41.6%) and increased pulse wave velocity (20.1%) were common. Office systolic blood pressure SD score was independently associated with all surrogate markers.

Conclusions:

• Baseline data from a large pediatric cohort reveal a strong association between cardiovascular disease surrogate markers and systolic hypertension.
• The stage of chronic kidney disease is also closely linked to these cardiovascular indicators in children.
• These findings underscore the importance of managing hypertension and monitoring cardiovascular health in pediatric CKD patients.