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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.).
Insights
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.
Abstract:
Carotid-femoral pulse wave velocity (cfPWV) is a measure of arterial stiffness associated with cardiovascular events in the general population and in adults with chronic kidney disease. However, few data exist regarding cfPWV in children with chronic kidney disease. We compared observed cfPWV assessed via applanation tonometry in children enrolled in the CKiD cohort study (Chronic Kidney Disease in Children) to normative data in healthy children and examined risk factors associated with elevated cfPWV. cfPWV Z score for height/gender and age/gender was calculated from and compared with published pediatric norms. Multivariable linear regression was used to assess the relationship between cfPWV and age, gender, race, body mass index, diagnosis, urine protein-creatinine ratio, mean arterial pressure, heart rate, number of antihypertensive medications, uric acid, and serum low-density lipoprotein. Of the 95 participants with measured cfPWV, 60% were male, 19% were black, 46% had glomerular cause of chronic kidney disease, 22% had urine protein-creatinine ratio 0.5 to 2.0 mg/mg and 9% had >2.0 mg/mg, mean age was 15.1 years, average mean arterial pressure was 80 mm Hg, and median glomerular filtration rate was 63 mL/min per 1.73 m2 Mean cfPWV was 5.0 m/s (SD, 0.8 m/s); mean cfPWV Z score by height/gender norms was -0.1 (SD, 1.1). cfPWV increased significantly with age, mean arterial pressure, and black race in multivariable analysis; no other variables, including glomerular filtration rate, were independently associated with cfPWV. In this pediatric cohort with mild kidney dysfunction, arterial stiffness was comparable to that of normal children. Future research is needed to examine the impact of chronic kidney disease progression on arterial stiffness and associated cardiovascular parameters in children.