Abstract
AbstractRationaleThe progression of cardiovascular disease (CVD) in children with chronic kidney disease (CKD) is not well understood.ObjectiveTo investigate carotid intima-media thickness (cIMT) as a surrogate marker for CVD in 670 patients of the 4C Study (The Cardiovascular Comorbidity in Children with CKD Study), aged 6 - 17 years, with CKD stage 3-5 at baseline. Patients were observed for a period of up to 8 years.Methods and ResultsA linear mixed model was employed to analyse the longitudinal course of cIMT standard deviation score (SDS) and associated clinical risk factors. The association between cIMT SDS change rate and systolic and diastolic BP SDS change rate per year was investigated. cIMT SDS increased significantly during the prospective observation period, with the slope of increase attenuating over time. Younger, taller and female patients were at an elevated risk for elevated cIMT SDS. Further risk factors included diastolic blood pressure and serum albumin for all patients, albuminuria in progressive CKD, and serum phosphate in stable CKD. Diastolic blood pressure SDS decreased and its effect on cIMT SDS attenuated over time. The yearly diastolic and systolic blood pressure change rates were associated with the cIMT SDS change rate within the first 4.5 years. This indicates a progressive change in cIMT with increasing blood pressure over time, and a decrease in cIMT with lowering of blood pressure.ConclusionsThe results demonstrate a progressive increase in cIMT over time in children with CKD, with traditional risk factors such as albuminuria, serum phosphate and blood pressure as relevant predictive factors for cIMT SDS. The association of cIMT SDS progression with blood pressure dynamics suggests potential benefits of blood pressure control in children with CKD. Our findings indicate that cIMT may serve as a surrogate parameter for future clinical trials in children.
Publisher
Cold Spring Harbor Laboratory