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Vascular Stiffness in Children With Chronic Kidney Disease
Jonathan D Savant1, Aisha Betoko1, Kevin E C Meyers1
1From the Department of Pediatrics, The Children's Hospital of Philadelphia, PA (J.D.S., K.E.C.M., S.L.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (K.E.C.M., R.R.T., S.L.F.); Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.); Division of Nephrology, Seattle Children's Hospital, WA (J.T.F.); Emory University and Children's Healthcare of Atlanta, GA (L.A.G.); Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada (A.D.); and Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO (B.W.).
Arterial stiffness, measured by carotid-femoral pulse wave velocity (cfPWV), was similar in children with chronic kidney disease compared to healthy peers. cfPWV increased with age, blood pressure, and Black race in this pediatric cohort.
Area of Science:
- Cardiovascular Research
- Pediatric Nephrology
- Vascular Biology
Background:
- Carotid-femoral pulse wave velocity (cfPWV) is a validated biomarker for arterial stiffness and cardiovascular risk in adults.
- While established in adults, cfPWV data in pediatric chronic kidney disease (CKD) populations are scarce.
- Understanding arterial stiffness in children with CKD is crucial for early cardiovascular risk stratification.
Purpose of the Study:
- To compare cfPWV in children with CKD to healthy pediatric norms.
- To identify risk factors associated with elevated cfPWV in pediatric CKD.
- To assess arterial stiffness in a pediatric cohort with mild kidney dysfunction.
Main Methods:
- Carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry in children from the CKiD cohort.
- cfPWV Z-scores were calculated relative to height/gender and age/gender pediatric norms.
- Multivariable linear regression analyzed associations between cfPWV and clinical factors including age, MAP, race, and kidney function markers.
Main Results:
- The pediatric CKD cohort (N=95) exhibited a mean cfPWV Z-score of -0.1 (SD 1.1), comparable to healthy children.
- cfPWV demonstrated significant positive associations with increasing age, mean arterial pressure (MAP), and Black race.
- Glomerular filtration rate (GFR) and other assessed variables were not independently associated with cfPWV in this cohort.
Conclusions:
- Children with mild CKD show arterial stiffness comparable to healthy peers.
- Age, MAP, and race are key determinants of cfPWV in pediatric CKD.
- Further longitudinal studies are warranted to track arterial stiffness changes with CKD progression in children.