CKD may thicken carotid arteries, raise CVD risk in children

Oct 16 2012

By Lauretta Ihonor, medwireNews Reporter

Findings from a US study show that carotid intima-media thickness (cIMT) is significantly higher among children with mild-to-moderate chronic kidney disease (CKD) than in children without the kidney condition.

The majority of the children with CKD were hypertensive (76%) and dyslipidemic (55%), suggesting "that children with CKD are at increased cardiovascular risk," say Tammy Brady (Johns Hopkins University, Baltimore, Maryland) and co-authors.

They add: "What makes our results particularly striking is that this finding still holds among children without extreme kidney dysfunction or end stage renal disease compared with normative data obtained in a more racially diverse, representative group of healthy controls."

In light of this, the authors advise that all children with kidney disease should be closely monitored for the presence of hypertension and hypercholesterolemia, and immediately treated if either condition develops.

The CKD study involved the assessment of cIMT measurements taken from 101 US children aged 2-18 years (median 12.4 years) with mild-to-moderate CKD, defined as a Schwartz-estimated glomerular filtration rate (eGFR) of 30-90 mL/min per 1.73m².

These cIMT measurements, captured via B-mode ultrasound scan, were compared with those of 97 CKD-free, age-matched controls.

Brady et al report that the median cIMT of children with CKD was a significant 0.02 mm greater than that of CKD-free controls (0.43 versus 0.41 mm), even after adjustment for age, gender, and race.

Linear regression analysis revealed that the presence of dyslipidemia and hypertension increased mean cIMT by 0.05 and 0.04 mm, respectively.

Other cardiovascular disease (CVD) risk factors, including body mass index, serum calcium and phosphorus levels, gender, and race did not show a significant association with cIMT.

Brady and co-authors hypothesize that "there may be other characteristics unique to CKD that influence the effect of dyslipidemia on the vasculature."

They conclude that these CKD study findings emphasize a need for further research into the effect of "targeted dyslipidemia and hypertension treatment normalizing cIMT and decreasing adverse cardiovascular outcomes among children with CKD."

The study is published online in the Clinical Journal of the American Society of Nephrology.

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