Skip to main content

Advertisement

Log in

Flow-mediated vasodilatation of the brachial artery in children with chronic kidney disease

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

We sought to determine flow-mediated vasodilatation (FMD) of the brachial artery and to assess the relationship of FMD with multiple demographic, clinical and biochemical parameters and cardiac and vascular structure and function in children with chronic kidney disease (CKD) stages 2–4. Forty-three patients, aged 6–20 years, with CKD [mean glomerular filtration rate (GFR) 47 ± 21 ml/min per 1.73 m2 body surface area, range 16–89 ml/min per 1.73 m2] and 34 healthy age-matched controls were included and studied cross-sectionally between 2001 and 2005. The peak FMD was similar in the CKD and control subjects (mean 6.3% vs 6.7%, P = 0.85). However, abnormally low FMD (< 1.1%) was found in ten (23%) children with CKD. Among children with CKD, those with low FMD were younger, shorter, lighter, and had lower body mass index (BMI) than children with normal FMD, but the difference reached statistical significance only for weight and BMI. Serum triglyceride levels were significantly lower in those with low FMD; otherwise, the two groups were similar with respect to multiple clinical and biochemical parameters. Cardiac and vascular structure was similar in children with normal and low FMD. In conclusion, children with CKD stage 2–4 appear to have increased prevalence of decreased FMD of the brachial artery. However, our study identified few significant factors associated with low FMD in children with CKD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126

    Article  CAS  Google Scholar 

  2. Linder L, Kiowski W, Bühler FR, Lüsher TF (1990) Indirect evidence for release of endothelium-derived relaxing factor in human forarm circulation in vivo. Blunted response in essential hypertension. Circulation 81:1762–1767

    Article  CAS  Google Scholar 

  3. Panza JA, Quyyumi AA, Brush JE, Epstein SE (1990) Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med 323:22–27

    Article  CAS  Google Scholar 

  4. Clarkson P, Celermajer DS, Powe AJ, Donald AE, Henry RMA, Deanfield JE (1997) Endothelium-dependent dilatation is impaired in young healthy subjects with a family history of premature coronary disease. Circulation 96:3378–3383

    Article  CAS  Google Scholar 

  5. Van Guldener C, Lambert J, Janssen MJ, Donker AJ, Stehouwer CD (1997) Endothelium-dependent vasodilatation and distensibility of large arteries in chronic hemodialysis patients. Nephrol Dial Transplant 12(Suppl 2):14–18

    PubMed  Google Scholar 

  6. Van Guldener C, Janssen MJ, Lambert J, Steyn M, Donker AJ, Stehouwer CD (1998) Endothelium-dependent vasodilatation is impaired in peritoneal dialysis patients. Nephrol Dial Transplant 13:1782–1786

    Article  Google Scholar 

  7. Hausberg M, Kisters K, Kosch M, Rahn KH, Barenbrock M (1999) Flow-mediated vasodilation and distensibility of the brachial artery in renal allograft recipients. Kidney Int 55:1104–1110

    Article  CAS  Google Scholar 

  8. Pannier B, Guerin AP, Marchais SJ, Metivier F, Safar ME, London GM (2000) Postischemic vasodilation, endothelial activation, and cardiovascular remodeling in end-stage renal disease. Kidney Int 57:1091–1099

    Article  CAS  Google Scholar 

  9. Dogra G, Irish A, Chan D, Watts G (2006) Insulin resistance, inflammation, and blood pressure determine vascular dysfunction in CKD. Am J Kidney Dis 48:926–934

    Article  CAS  Google Scholar 

  10. Yilmaz MI, Saglam M, Caglar K, Cakir E, Sonmez A, Ozgurtas T, Aydin A, Eyileten T, Ozcan O, Acikel C, Tasar M, Genctoy G, Erbil K, Vural A, Zoccali C (2006) The determinants of endothelial dysfunction in CKD: oxidative stress and asymmetric dimethylarginine. Am J Kidney Dis 47:42–50

    Article  CAS  Google Scholar 

  11. Celermajer DS, Sorenson KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloyd JK, Deanfield JE (1992) Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 340:1111–1115

    Article  CAS  Google Scholar 

  12. Meyer AA, Kundt G, Steiner M, Schuff-Werner P, Kienast W (2006) Impaired flow-mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: the impact of cardiovascular risk factors. Pediatrics 117:1560–1567

    Article  Google Scholar 

  13. Järvisalo MJ, Raitakari M, Toikka JO, Putto-Laurila A, Rontu R, Laine S, Lehtimäki T, Rönnemaa T, Viikari J, Raitakari OT (2004) Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes. Circulation 109:1750–1755

    Article  Google Scholar 

  14. Kari J, Donald AE, Vallance DT, Bruckdorfer KR, Leone A, Mullen MJ, Bunce T, Dorado B, Deanfield JE, Rees L (1997) Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int 52:468–472

    Article  CAS  Google Scholar 

  15. Lilien MR, Schröder CH, Levtchenko EN, Koomans HA (2004) Growth hormone therapy influences endothelial function in children with renal failure. Pediatr Nephrol 19:785–789

    Article  Google Scholar 

  16. Lilien MR, Stroes ES, Op’t Roodt J, de Jongh S, Schröder CH, Koomans HA (2003) Vascular function in children after renal transplantation. Am J Kidney Dis 41:684–691

    Article  Google Scholar 

  17. Lilien MR, Koomans HA, Schröder CH (2005) Hemodialysis acutely impairs endothelial function in children. Pediatr Nephrol 20:200–204

    Article  Google Scholar 

  18. Stake G, Monclair T (1991) A single plasma sample method for estimation of the glomerular filtration rate in infants and children using iohexol, I: establishment of a body weight-related formula for the distribution volume of iohexol. Scand J Clin Lab Invest 51:335–342

    Article  CAS  Google Scholar 

  19. 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

    Article  CAS  Google Scholar 

  20. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R, International Brachial Artery Reactivity Task Force (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery. J Am Coll Cardiol 16:257–265

    Article  Google Scholar 

  21. Lai H, Kartal J, Mitsnefes MM (2007) Hyperinsulinemia in pediatric patients with chronic kidney disease: the role of tumor necrosis factor-a. Pediatr Nephrol 22:1751–1756

    Article  Google Scholar 

  22. Bennett-Richards K, Kattenhorn M, Donald A, Oakley G, Varghese Z, Rees L, Deanfield JE (2002) Does oral folic acid lower total homocysteine levels and improve endothelial function in children with chronic renal failure. Circulation 105:1810–1815

    Article  CAS  Google Scholar 

  23. Bennett-Richards KJ, Kattenhorn M, Donald AE, Oakley GR, Varghese Z, Bruckdorfer KR, Deanfield JE, Rees L (2002) Oral L-arginine does not improve endothelial dysfunction in children with chronic renal failure. Kidney Int 62:1372–1378

    Article  CAS  Google Scholar 

  24. Caglar K, Yilmaz MI, Saglam M, Cakir E, Acikel C, Eyileten T, Yenicesu M, Oguz Y, Vural A, Carrero JJ, Axelsson J, Lindholm B, Stenvinkel P (2008) Short-term treatment with sevelamer increases serum fetuin-A concentration and improves endothelial dysfunction in chronic kidney disease stage 4 patients. Clin J Am Soc Nephrol 3:61–68

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark Mitsnefes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilson, A.C., Urbina, E., Witt, S.A. et al. Flow-mediated vasodilatation of the brachial artery in children with chronic kidney disease. Pediatr Nephrol 23, 1297–1302 (2008). https://doi.org/10.1007/s00467-008-0815-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-008-0815-0

Keywords

Navigation