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Evaluation of aortic stiffness in children with chronic renal failure

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Abstract

The measurement of aortic stiffness (As) [aortic strain (S), pressure strain elastic modulus (Ep) and pressure strain normalized by diastolic pressure (Ep*)] is suggested as an excellent marker of subclinical arterial sclerosis. We aimed to investigate the presence of As and to determine the relationship between As and some risk factors in children with chronic renal failure (CRF). Twenty-six pre-dialysis (PreD) [female/male (F/M) 7/19] patients and 23 chronic peritoneal dialysis (CPD) (F/M 13/10) patients were assessed. Twenty-nine healthy children were selected as a control group (F/M 14/15). We determined anemia, abnormal calcium/phosphate metabolism, hypertension, diastolic dysfunction, increased left ventricular mass (LVM), hypertriglyceridemia, increased stiffness (Ep, Ep*), and decreased strain (S) in the CRF (PreD and CPD) group compared with the controls (P < 0.05). Presence of renal disease, LVM and usage of angiotensin-converting enzyme inhibitor (ACE-I) in all groups; female gender, duration of disease and the usage of anti-hypertensive drug therapy in CRF patients; and LVM and LVM index in healthy children were found to be independent predictors for aortic stiffness and/or strain. In conclusion, CRF is associated with significant arterial functional abnormalities in uremic children and not controlled by dialysis treatment. These results suggest that, even in young children, uremia has a profound impact on arterial function.

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References

  1. 1.

    Aksu N, Yavascan O, Erdogan H, Dorak MC, Kansoy S, Kozan M (1998) Echocardiographic evaluation in children treated with CAPD. Adv Perit Dial 14:255–257

  2. 2.

    Prichard S, Sniderman A, Cianflone K, Marpole D (1996) Cardiovascular disease in peritoneal dialysis. Perit Dial Int 16 [Suppl 1]:S19–S22

  3. 3.

    Chavers BM, Li S, Collins AJ, Herzog CA (2002) Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 62:648–653

  4. 4.

    Harnett JD, Kent GM, Barre PE, Taylor R, Parfrey PS (1994) Risk factors for development of left ventricular hypertrophy in a prospectively followed cohort of dialysis patients. J Am Soc Nephrol 4:1486–1490

  5. 5.

    Nichols WW, O’Rourke MF (1998) Vascular impedance. In: McDonalds’s blood flow in arteries: theoretical, experimental and clinical principles, 4th edn. Edward Arnold, London, UK, pp 243–293

  6. 6.

    Guérin AP, London GM, Marchais SJ, Metivier F (2000) Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 15:1014–1021

  7. 7.

    Lacombe F, Dart A, Dewar E, Jennings G, Cameron J, Laufer E (1992) Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 13:1040–1045

  8. 8.

    Okubo M, Ino T, Takahashi K, Kishiro M, Akimoto K, Yamashiro Y (2001) Age dependency of stiffness of the abdominal aorta and the mechanical properties of the aorta in Kawasaki disease in children. Pediatr Cardiol 22:198–203

  9. 9.

    Imura T (1985) Non-invasive measurement of the elastic properties of the abdominal aorta and analyses of aging change—changes of elasticity of the aorta by aging. Hokkaido Igaku Zasshi 60:653–661

  10. 10.

    Levent E, Goksen D, Ozyurek AR, Darcan S, Coker M (2002) Stiffness of the abdominal aorta in obese children. J Pediatr Endocrinol Metab 15:405–409

  11. 11.

    Levent E, Ozyurek AR, Ulger Z (2004) Evaluation of aortic stiffness in tobacco-smoking adolescents. J Adolesc Health 34:339–343

  12. 12.

    Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium–phosphorus metabolism. J Am Soc Nephrol 16:2796–2803

  13. 13.

    Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500

  14. 14.

    Robinson RF, Nahata MC, Sparks E, Daniels C, Batisky DL, Hayes JR, Mahan JD (2005) Abnormal left ventricular mass and aortic strain in pediatric dialysis patients. Pediatr Nephrol 20:64–68

  15. 15.

    Groothoff JW, Lilien MR, van de Kar NC, Wolff ED, Davin JC (2005) Cardiovascular disease as a late complication of end-stage renal disease in children. Pediatr Nephrol 20:374–379

  16. 16.

    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy finding. J Am Coll Cardiol 57:450–458

  17. 17.

    De Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitis O, Alderman MH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260

  18. 18.

    Covic A, Gusbeth-Tatomir P, Goldsmith DJA (2005) Arterial stiffness in renal patients: an update. Am J Kidney Dis 45:965–977

  19. 19.

    Goldsmith DJ, Covic A (2001) Coronary artery disease in uremia: etiology, diagnosis, and therapy. Kidney Int 60:2059–2078

  20. 20.

    Toz H, Duman S, Altunel E, Sezis M, Ozbek S, Ozkahya M, Asci G, Ok E, Basci A (2004) Intima media thickness as a predictor of atherosclerosis in renal transplantation. Transplant Proc 36:156–158

  21. 21.

    De Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062

  22. 22.

    Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM (1998) Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension 32:570–574

  23. 23.

    Barenbrock M, Kosch M, Joster E, Kisters K, Rahn KH, Hausberg M (2002) Reduced arterial distensibility is a predictor of cardiovascular disease in patients after renal transplantation. J Hypertens 20:79–84

  24. 24.

    Dijk JM, Algra A, van der GY, Grobbee DE, Bots ML (2005) Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study. Eur Heart J 26:1213–1220

  25. 25.

    Paini A, Boutouyrie P, Calvet D, Tropeano AI, Laloux B, Laurent S (2006) Carotid and aortic stiffness: determinants of discrepancies. Hypertension 47:371–376

  26. 26.

    Lakatta EG, Levy D (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Part II. The aging heart in health: links to heart disease. Circulation 107:346–354

  27. 27.

    Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629

  28. 28.

    Hayashi T, Nakayama Y, Tsumura K, Yoshimaru K, Ueda H (2002) Reflection in the arterial system and the risk of coronary heart disease. Am J Hypertens 15:405–409

  29. 29.

    Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105

  30. 30.

    Shinohara K, Shoji T, Tsujimoto Y, Kimoto E, Tahara H, Koyama H, Emoto M, Ishimura E, Miki T, Tabata T, Nishizawa Y (2004) Arterial stiffness in predialysis patients with uremia. Kidney Int 65:936–943

  31. 31.

    Muesing RA, Forman MR, Graubard BI, Beecher GR, Lanza E, McAdam PA, Campbell WS, Olson BR (1996) Cyclic changes in lipoprotein and apolipoprotein levels during the menstrual cycle in healthy premenopausal women on a controlled diet. J Clin Endocrinol Metab 81:3599–3603

  32. 32.

    Shoji T, Nishizawa Y, Kawagishi T, Kawasaki K, Taniwaki H, Tabata T, Inoue T, Morii H (1998) Intermediate-density lipoprotein as an independent risk factor for aortic atherosclerosis in hemodialysis patients. J Am Soc Nephrol 9:1277–1284

  33. 33.

    Covic A, Mardare N, Gusbeth-Tatomir P, Brumaru O, Gavrilovici C, Munteanu M, Prisada O, Goldsmith DJ (2006) Increased arterial stiffness in children on haemodialysis. Nephrol Dial Transplant 21:729–735

  34. 34.

    Groothoff JW, Gruppen MP, Offringa M, de Groot E, Stok W, Bos WJ, Davin JC, Lilien MR, Van de Kar NC, Wolff ED, Heymans HS (2002) Increased arterial stiffness in young adults with end-stage renal disease since childhood. J Am Soc Nephrol 13:2953–2961

  35. 35.

    London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, Metivier F (1996) Cardiac and arterial interactions in end-stage renal disease. Kidney Int 50:600–608

  36. 36.

    Barenbrock M, Spieker C, Laske V, Heidenreich S, Hohage H, Bachmann J, Hoeks AP, Rahn KH (1994) Studies of the vessel wall properties in hemodialysis patients. Kidney Int 45:1397–1400

  37. 37.

    Schiffrin EL (2003) Effect of antihypertensive treatment on small artery remodeling in hypertension. Can J Physiol Pharmacol 81:168–176

  38. 38.

    Schiffrin EL (2001) Small artery remodelling in hypertension: can it be corrected? Am J Med Sci 322:7–11

  39. 39.

    Takami T, Shigematsu M (2003) Effects of calcium channel antagonists on left ventricular hypertrophy and diastolic function in patients with essential hypertension. Clin Exp Hypertens 25:525–535

  40. 40.

    Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM (2001) Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 38:938–942

  41. 41.

    Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483

  42. 42.

    Rossert J, Froissart M, Jacquot C (2005) Anemia management and chronic renal failure progression. Kidney Int 68 [Suppl 99]:S76–S81

  43. 43.

    Ayus JC, Go AS, Valderrabano F, Verde E, de Vinuesa SG, Achinger SG, Lorenzo V, Arieff AI, Luno J; Spanish Group for the Study of the Anemia and Left Ventricular Hypertrophy in Pre-dialysis Patients (2005) Effects of erythropoietin on left ventricular hypertrophy in adults with severe chronic renal failure and hemoglobin < 10 g/dl. Kidney Int 68:788–795

  44. 44.

    Milliner DS, Zinsmelster AR, Lieberman E, Landing B (1990) Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 38:931–936

  45. 45.

    Blacher J, Demuth K, Guerin AP, Safar ME, Moatti N, London GM (1998) Influence of biochemical alterations on arterial stiffness in patients with end-stage renal disease. Arterioscler Thromb Vasc Biol 18:535–541

  46. 46.

    Nishizawa Y, Shoji T, Emoto M, Koyama H, Tahara H, Fukumoto S, Inaba M, Ishimura E, Miki T (2004) Roles of metabolic and endocrinological alterations in atherosclerosis and cardiovascular disease in renal failure: another form of metabolic syndrome. Semin Nephrol 24:423–425

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Correspondence to Onder Yavascan.

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Bakiler, A.R., Yavascan, O., Harputluoglu, N. et al. Evaluation of aortic stiffness in children with chronic renal failure. Pediatr Nephrol 22, 1911–1919 (2007) doi:10.1007/s00467-007-0562-7

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Keywords

  • Aortic stiffness
  • Cardiovascular assessment
  • Chronic renal failure
  • End-stage renal failure
  • Children