The burden of subclinical cardiovascular disease in children and young adults with chronic kidney disease and on dialysis

Alexander D Lalayiannis; Charles J Ferro; David C Wheeler; Neill D Duncan; Colette Smith; Joyce Popoola; Varvara Askiti; Andromachi Mitsioni; Amrit Kaur; Manish D Sinha; Simon P McGuirk; Kristian H Mortensen; David V Milford; Rukshana Shroff

doi:10.1093/ckj/sfab168

The burden of subclinical cardiovascular disease in children and young adults with chronic kidney disease and on dialysis

Clin Kidney J. 2021 Sep 14;15(2):287-294. doi: 10.1093/ckj/sfab168. eCollection 2022 Feb.

Authors

Affiliations

¹ University College London Great Ormond Street Hospital Institute of Child Health, London, UK.
² University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³ Department of Renal Medicine, University College London, London, UK.
⁴ Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
⁵ Institute of Global Health, University College London, London, UK.
⁶ Department of Nephrology and Transplantation, St. George's University Hospital NHS Foundation Trust, London, UK.
⁷ "P. & A. Kyriakou" Childrens' Hospital, Athens, Greece.
⁸ Manchester University NHS Foundation Trust, Manchester, UK.
⁹ Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.
¹⁰ Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.

Abstract

Background: Cardiovascular disease (CVD) is a common cause of morbidity and mortality even in young people with chronic kidney disease (CKD). We examined structural and functional CV changes in patients ˂30 years of age with CKD Stages 4 and 5 and on dialysis.

Methods: A total of 79 children and 21 young adults underwent cardiac computed tomography for coronary artery calcification (CAC), ultrasound for carotid intima-media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV) and echocardiography. Differences in structural (CAC, cIMT z-score, left ventricular mass index) and functional (carotid distensibility z-score and cfPWV z-score) measures were examined between CKD Stages 4 and 5 and dialysis patients.

Results: Overall, the cIMT z-score was elevated [median 2.17 (interquartile range 1.14-2.86)] and 10 (10%) had CAC. A total of 16/23 (69.5%) patients with CKD Stages 4 and 5 and 68/77 (88.3%) on dialysis had at least one structural or functional CV abnormality. There was no difference in the prevalence of structural abnormalities in CKD or dialysis cohorts, but functional abnormalities were more prevalent in patients on dialysis (P < 0.05). The presence of more than one structural abnormality was associated with a 4.5-fold increased odds of more than one functional abnormality (95% confidence interval 1.3-16.6; P < 0.05). Patients with structural and functional abnormalities [cIMT z-score >2 standard deviation (SD) or distensibility <-2 SD) had less carotid dilatation (lumen:wall cross-sectional area ratio) compared with those with normal cIMT and distensibility.

Conclusions: There is a high burden of subclinical CVD in young CKD patients, with a greater prevalence of functional abnormalities in dialysis compared with CKD patients. Longitudinal studies are required to test these hypothesis-generating data and define the trajectory of CV changes in CKD.

Keywords: cardiovascular disease; carotid intima–media thickness; chronic kidney disease; coronary artery calcification; pulse wave velocity.