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Cardiovascular Risk in Pediatric Renal Transplant Recipients
Fernando Kazuaki Hamamoto1, Maria do Carmo Franco2, Maria Fernanda Silva Jardim3
1Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil.
Insights
Kidney transplantation benefits cardiovascular health in children with chronic kidney disease (CKD). Long-term monitoring is crucial due to potential future dialysis needs and transplant limitations.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in CKD
- Renal Transplantation Outcomes
Background:
- Pediatric chronic kidney disease (CKD) survival has improved, but cardiovascular disease (CVD) remains the leading cause of mortality.
- CKD patients face significant cardiovascular risks, necessitating focused research.
Purpose of the Study:
- To assess cardiovascular risk in children with CKD one year post-kidney transplantation.
- To investigate associations between cardiovascular risk and biochemical markers, including novel ones.
Main Methods:
- An observational, ambidirectional study of 75 pediatric patients post-renal transplant (2003-2013) with ≥1 year follow-up.
- Outcome variables included left ventricular (LV) mass Z-score and coronary calcification (calcium Agatston score).
Main Results:
- Low incidence of cardiovascular changes observed: 1 patient with elevated calcium score, 3 children (4%) with LV mass Z-score ≥ 2.0.
- Multivariable analysis identified gender, serum triglyceride, and serum renalase concentration as significantly associated with LV mass.
Conclusions:
- Kidney transplantation appears beneficial for pediatric cardiovascular health.
- Long-term follow-up is recommended due to transplant limitations and potential future dialysis or re-transplantation needs.
Background:
The survival of pediatric chronic kidney disease (CKD) patients has improved in recent decades due to advances in dialysis and transplantation. However, cardiovascular disease (CVD) emerges as the main cause of mortality in patients with CKD.
Objectives:
To estimate cardiovascular risk in children with CKD at least 1 year after kidney transplantation. In addition, the possible association of cardiovascular risk with classic biochemical markers and potential new markers of this outcome was investigated.
Methods:
An observational ambidirectional (retrospective capture of risk factors and prospective study of outcomes) research including 75 patients who underwent renal transplant between 2003 and 2013 with postoperative follow-up of at least 1 year was conducted. The outcome variables adopted were the LV mass Z-score and the presence of coronary calcification on computed tomography using calcium Agatston score.
Result:
Only one patient had an elevated calcium score, and three children (4%) had an LV mass Z-score ≥ 2.0. After multivariable analysis, only gender, serum triglyceride, and serum renalase concentration remained significantly associated with LV mass.
Conclusion:
The low incidence of cardiovascular changes in the population studied confirms the benefit of transplantation for the cardiovascular health of children. Nevertheless, long-term follow-up of these patients is recommended, given the limited duration of kidney function provided by transplantation and the high likelihood of further dialysis and kidney transplants being required in these children.
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