ESPN 53rd Annual Meeting

ESPN 2021


 
Factors associated with longitudinal changes of pulse wave velocity (PWV) in children with chronic kidney disease (CKD)
KAROLIS AZUKAITIS 1 MARIETTA KIRCHNER 2 ANKE DOYON 3 MIECZYSłAW LITWIN 4 AYSUN BAYAZIT 5 ALI DUZOVA 6 NUR CANPOLAT 7 AUGUSTINA JANKAUSKIENE 1 RUKSHANA SHROFF 8 ANETTE MELK 9 UWE QUERFELD 10 FRANZ SCHAEFER 3 ON BEHALF OF 4C STUDY CONSORTIUM 11

1- CLINIC OF PEDIATRICS, INSTITUTE OF CLINICAL MEDICINE, FACULTY OF MEDICINE, VILNIUS UNIVERSITY, VILNIUS, LITHUANIA
2- INSTITUTE OF MEDICAL BIOMETRY AND INFORMATICS, UNIVERSITY OF HEIDELBERG, HEIDELBERG, GERMANY
3- DIVISION OF PEDIATRIC NEPHROLOGY, CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG UNIVERSITY HOSPITAL, HEIDELBERG, GERMANY
4- DEPARTMENT OF NEPHROLOGY AND ARTERIAL HYPERTENSION, THE CHILDRENS MEMORIAL HEALTH INSTITUTE, WARSAW, POLAND
5- DEPARTMENT OF PEDIATRIC NEPHROLOGY, CUKUROVA UNIVERSITY, ADANA, TURKEY
6- DIVISION OF PEDIATRIC NEPHROLOGY, HACETTEPE UNIVERSITY FACULTY OF MEDICINE, ANKARA, TURKEY
7- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTANBUL UNIVERSITY CERRAHPASA FACULTY OF MEDICINE, ISTANBUL, TURKEY
8- GREAT ORMOND STREET HOSPITAL FOR CHILDREN, LONDON, UK
9- DEPARTMENT OF KIDNEY, LIVER AND METABOLIC DISEASES, HANNOVER MEDICAL SCHOOL, HANNOVER, GERMANY
10- DEPARTMENT OF PEDIATRIC NEPHROLOGY, CHARITé UNIVERSITY, BERLIN, GERMANY
11- 4C STUDY CONSORTIUM
 
Introduction:

Uremia has a profound effect on arterial elasticity and increased PWV has been reported in children with CKD, but comprehensive description of arterial stiffening risk profile is still lacking. The aim of the present analysis was to evaluate risk factors associated with PWV over time in children with CKD.

Material and methods:

Post-hoc analysis of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study that prospectively followed children aged 6-17 years with CKD stages 3-5. Follow-up was censored at the start of kidney replacement therapy. PWV was measured with an oscillometric device (Vicorder) and standardized to sex and height (PWVz). Multivariable linear longitudinal mixed-effects models with patient-individual random intercepts and slopes were built to determine the associations of each covariate with PWVz (censored at age 17 years due to lack of reference values thereafter) and absolute PWV (all observations).

Results:

667 patients (12.2±3.3 years, 65.5% boys) with a median baseline eGFR of 26.9 ml/min/1.73 m2 and baseline PWVz of 0.31±1.65 were analyzed. Median follow-up of study participants was 1.7 years.

PWVz (n=628) showed time-stable associations with younger age (-0.055, p=0.002), lower height z-score (-0.329, p<0.001), higher diastolic blood pressure (BP) z-score (0.332, p<0.001), higher serum low-density lipoprotein (LDL) cholesterol (0.003, p=0.02), higher serum calcium (0.549, p=0.05), higher albuminuria (0.107, p=0.001) and lower ferritin (-0.117, p=0.01).  In addition, time-interaction analysis revealed an intensifying effect of lower height z-score (p=0.03) and female gender (0.161, p=0.01 for time-interaction) over time. In a model with absolute PWV values greater height and older age were associated with higher PWV, as expected physiologically; the effect of female gender was lost, while other associations remained.

Conclusions:

 Higher PWV in children with CKD associates with non-modifiable (age, height, female gender) and potentially modifiable (BP, LDL cholesterol, albuminuria, serum calcium and ferritin) factors but not kidney function.