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Updated: Aug 31, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Arterial Stiffness and Chronic Kidney Disease Progression in Children
Karolis Azukaitis1, Marietta Kirchner2, Anke Doyon3
1Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Insights
Arterial stiffness, measured by pulse wave velocity, is elevated in children with chronic kidney disease (CKD). However, this increased stiffness does not predict CKD progression in this pediatric population.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Chronic Kidney Disease Research
Background:
- Arterial stiffness is a known complication of chronic kidney disease (CKD) in adults, but its implications in pediatric CKD are not well-established.
- Conflicting data exist regarding the association between arterial stiffness and CKD in children, necessitating further investigation.
Purpose of the Study:
- To examine the longitudinal changes and influencing factors of pulse wave velocity (PWV) in children with CKD.
- To determine the relationship between PWV and the progression of CKD in pediatric patients.
Main Methods:
- Analysis of the prospective Cardiovascular Comorbidity in Children with CKD (4C) study, including 667 children (aged 6-17 years) with CKD stages 3-5.
- Assessment of absolute PWV and height-standardized PWV (z-score) as primary and sensitivity outcomes, respectively, with follow-up censored at kidney replacement therapy (KRT) initiation.
- Statistical analysis to identify determinants of PWV and its association with CKD progression, adjusting for established risk factors like eGFR, proteinuria, and blood pressure.
Main Results:
- A significant proportion (20%) of children with CKD had elevated PWV at baseline.
- Absolute PWV increased over time, associated with older age, higher blood pressure, LDL cholesterol, and albuminuria.
- Height-standardized PWV (z-score) remained stable but was influenced by factors including diastolic blood pressure z-score, height z-score, younger age, and sex.
- Despite elevated PWV, the height-standardized PWV z-score did not correlate with CKD progression in univariable or multivariable analyses.
Conclusions:
- Children with CKD exhibit increased arterial stiffness (PWV).
- Elevated PWV in pediatric CKD does not appear to be a predictor of CKD progression.
- Further research is needed to understand the clinical significance of arterial stiffness in pediatric CKD.
Background And Objectives:
CKD has been linked to increased arterial stiffness in adults, but data in children with CKD remain conflicting. We aimed to investigate the longitudinal dynamics and determinants of pulse wave velocity in children with CKD and its association with CKD progression.
Design, Setting, Participants, & Measurements:
We performed an analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study, which prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the time of KRT initiation. Two separate analyses were performed: with absolute pulse wave velocity (primary outcome) and with pulse wave velocity standardized to height (z score; restricted to participants ≤17 years) as a sensitivity analysis.
Results:
In total, 667 patients with a mean baseline eGFR of 27 ml/min per 1.73 m2 were included. Pulse wave velocity above the 95th percentile was observed in 124 (20%) patients at baseline. Absolute pulse wave velocity increased gradually over the median follow-up of 2.7 (interquartile range, 0.7-4.4) years, whereas pulse wave velocity z score remained relatively stable. Absolute pulse wave velocity over time associated with time; older age; higher mean arterial pressure, LDL cholesterol, and albuminuria; and lower ferritin. Pulse wave velocity z score (n=628) was associated with the same variables and additionally, with higher diastolic BP z score, lower height z score, younger age, and girls. Of 628 patients, 369 reached the composite end point of CKD progression (50% eGFR loss, eGFR <10 ml/min per 1.73 m2, or the start of KRT) during a median follow-up of 2.4 (interquartile range, 0.9-4.6) years. Pulse wave velocity z score did not associate with CKD progression by univariable or multivariable proportional hazard analysis correcting for the established predictors eGFR, proteinuria, and BP.
Conclusions:
Pulse wave velocity is increased in children with CKD but does not associate with eGFR or CKD progression.
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