Vascular Stiffness in Children With Chronic Kidney Disease

• Authors: Jonathan D. Savant, The Children’s Hospital of Philadelphia; Aisha Betoko, Johns Hopkins Bloomberg School of Public Health; Keven E.C. Meyers, The Children’s Hospital of Philadelphia; Mark Mitsnefes, Cincinnati Children’s Hospital Medical Center; Joseph T. Flynn, Seattle Children’s Hospital; Raymond R. Townsend, University of Pennsylvania; Laurence Greenbaum, Emory University; Allison Dart, University of Manitoba; Bradley Warady, Children’s Mercy Hospital; Susan L. Furth, The Children’s Hospital of Philadelphia
• Journal Title: Hypertension
• Volume: Volume 69, Number 5
• Publisher: American Heart Association | 2017-05-01, Pages 863-869
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/HYPERTENSIONAHA.116.07653
• Subjects: Health Sciences, General; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Peripheral Vascular Disease; Cardiovascular System & Cardiology; arteriosclerosis; chronic kidney disease; pediatrics; pulse wave velocity; vascular stiffness; PULSE-WAVE VELOCITY; AMERICAN-HEART-ASSOCIATION; STAGE RENAL-DISEASE; ALL-CAUSE MORTALITY; ARTERIAL STIFFNESS; CARDIOVASCULAR EVENTS; BLOOD-PRESSURE; TRANSPLANTATION; METAANALYSIS; PREDICTION

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 m 2 . 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 asso ciated 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.