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Updated: Dec 30, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Aortic dilatation in children with mild to moderate chronic kidney disease
Peace C Madueme1, Derek K Ng2, Luke Guju3
1The Cardiac Center, Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA. Peace.madueme@nemours.org.
Insights
Aortic dilatation occurs in 6% of children with chronic kidney disease, linked to poor nutrition and blood pressure. This early finding highlights risks for cardiovascular issues in pediatric kidney disease patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Children with chronic kidney disease (CKD) face heightened cardiovascular risks.
- Cardiovascular sequelae are the primary cause of death in pediatric end-stage renal disease.
- Aortic dilatation is an emerging cardiovascular complication in pediatric CKD.
Purpose of the Study:
- To determine the prevalence of aortic dilatation in pediatric patients with mild to moderate CKD.
- To identify risk factors associated with aortic dilatation in this cohort.
Main Methods:
- Echocardiographic data from 501 children in the Chronic Kidney Disease in Children study were analyzed.
- Aortic dilatation was defined as a z-score > 2 at the aortic root, sinotubular junction, or ascending aorta.
- Multivariate analysis identified predictors of aortic dilatation.
Main Results:
- Aortic dilatation was present in 30 (6%) children at baseline.
- Higher diastolic blood pressure z-scores, lower weight z-scores, and lower BMI z-scores were associated with aortic dilatation.
- Protein energy wasting was the strongest independent predictor (OR 2.41).
Conclusions:
- Aortic dilatation is an early finding in pediatric chronic kidney disease.
- Poor nutrition markers, including protein energy wasting, are significantly associated with aortic dilatation.
- Longitudinal studies are needed to track risk factors as CKD progresses.
Background:
Children with mild to moderate chronic kidney disease are at an increased risk for cardiovascular sequelae, the leading cause of death in children with end-stage renal disease. We aimed to establish the prevalence of aortic dilatation, a newly recognized cardiovascular sequelae of renal disease, within a cohort of pediatric patients with mild to moderate kidney disease.
Methods:
A total of 501 children enrolled in the Chronic Kidney Disease in Children study contributed imaging data between April 2011 and February 2015. Aortic dilatation was defined as a dimension exceeding a z-score of 2 at any of three locations: aortic root, sinotubular junction, or the ascending aorta.
Results:
At baseline echocardiographic evaluation, 30 (6%) children were identified to have aortic dilatation in at least one of the three locations. Multivariate analysis demonstrated an increased odds ratio for the presence of aortic dilatation associated with the following variables: high diastolic blood pressure z-scores, low weight z-score, and low body mass index z-score. Presense of protein energy wasting (modified definition, OR 2.41, 95%CI 1.23, 4.70) was the strongest independent predictor of aortic dilatation.
Conclusion:
In conclusion, aortic dilatation does occur early in the course of chronic kidney disease and associates with markers of poor nutrition. Future studies should continue to evaluate these risk factors longitudinally as the kidney disease progresses.
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