Related Experiment Video
Updated: Aug 7, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiac Changes and Their Association with Fetuin-A and Fibroblast Growth Factor-23 in Children with Chronic Kidney
Abdullahi Mudi1, Hopewell Ntsinjana, Caroline Dickens
1Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Cardiac changes like left atrial enlargement occur in children with chronic kidney disease (CKD). Fetuin-A predicts left atrial changes, while hypertension and hypoalbuminemia require management in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Biochemistry
Background:
- Chronic kidney disease (CKD) in children is associated with cardiovascular complications.
- Fetuin-A and fibroblast growth factor-23 (FGF-23) are implicated in cardiac alterations in pediatric CKD.
- Understanding cardiac changes and their predictors is crucial for managing pediatric CKD.
Purpose of the Study:
- To determine the types and prevalence of cardiac changes in children with CKD.
- To investigate the association of cardiac changes with fetuin-A, FGF-23, and cardiovascular risk factors (CVRFs).
- To compare cardiac alterations across different stages of pediatric CKD.
Main Methods:
- A comparative cross-sectional study involving 88 children (5-18 years) with varying CKD stages.
- Assessment included demographic and clinical history, physical examination, routine blood tests, fetuin-A and FGF-23 assays.
- Echocardiography was performed to evaluate cardiac structure and function.
Main Results:
- Significant differences in left atrial diameter (LAD) and left ventricular (LV) mass were observed across CKD groups.
- Cardiac abnormalities included abnormal LAD (10%), LV hypertrophy (27%), and LV systolic dysfunction (6%).
- Fetuin-A predicted abnormal LAD; mean arterial pressure, age, and hypoalbuminemia were associated with LV hypertrophy subtypes. The dialysis group exhibited the highest rates of cardiac changes.
Conclusions:
- Left atrial changes, though not highly prevalent, are significant in pediatric CKD.
- Addressing modifiable CVRFs like hypertension and hypoalbuminemia is essential in managing cardiac health in children with CKD.
Aims:
In children with chronic kidney disease (CKD), fetuin-A and fibroblast growth factor-23 (FGF-23) have been implicated in the mechanism and progression of several cardiac changes. This study aimed to determine the types and rates of cardiac changes in children with CKD and their association with fetuin-A, FGF-23, and other cardiovascular risk factors (CVRFs).
Methods:
This comparative cross-sectional study recruited 88 children (5-18 years): 27 CKD I with a glomerular filtration rate (GFR) >90 mL/min/1.73 m2 and 61 with a GFR of <90 mL/min/1.73 m2 (29 CKD II-IV, 32 CKD V-dialysis). Each patient had a short demographic and clinical history taken along with a physical examination. Blood was taken and sent for routine tests and for fetuin-A and FGF-23 assay. All patients had an echocardiogram to evaluate cardiac structure and function.
Results:
The distribution of left atrial diameter (LAD) and left ventricular (LV) mass differed significantly (p < 0.05) across the different CKD groups. Abnormal LAD was seen in 10% of patients; LV hypertrophy (LVH) in 27%; LV systolic dysfunction in 6% and diastolic dysfunction in 1 patient. Fetuin-A was the only independent predictor for abnormal LAD; mean arterial pressure was independently associated with concentric LVH, and age and hypoalbuminemia with eccentric LVH. Overall, the dialysis group had the highest rate of cardiac changes and associated risk factors.
Conclusion:
Though not common, the importance of left atrial changes in children with CKD is highlighted along with the need to address modifiable CVRFs such as hypertension and hypoalbuminemia.
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:20Acute Kidney Injury V: Interprofessional Care
01:28Diabetic Nephropathy