Arterial remodeling and its relationship with blood pressure control in children with non-dialysis chronic kidney disease

Abstract

Objectives: To investigate large artery viscoelastic properties in children with non-dialysis stages of CKD and compare these with healthy children with normal renal function and (ii) to evaluate the impact of blood pressure components following adjustment for level of renal dysfunction. Methods: Prospective single centre study including 226 children [188 children with non-dialysis CKD (11.9 3.7 years) and 38 controls (11.5 3.3 years)] were recruited from tertiary out-patient clinics. Common carotid artery parameters were non-invasively determined using a high-definition echotracking system. Peripheral and central BP were also measured noninvasively. Results: When compared to controls, in children with CKD with similar levels of peripheral and central BP, anatomical measures of arterial properties such as lumen diameter and carotid wall thickness remained comparable. In those with BP >75th percentile there were significant differences between elastic properties of the carotid artery when compared with controls: distensibility (92 31 versus 114 33 kPa-1 x 103, pZ0.03), compliance (2.1 0.7 versus 2.6 0.7 m2 kPa-1 x 106, pZ0.02), Young’s elastic modulus (0.151 0.068 versus 0.109 0.049 kPa x 10-3, pZ0.02) and wall stress (83.6 23.5 versus 68.7 14.9 kPa, pZ0.02). These differences were independent of glomerular filtration rate (GFR). Multivariate regression analyses displayed brachial mean arterial pressure (MAP), carotid systolic and carotid pulse pressure were all associated with carotid artery functional elasticity following adjustment for age, body mass index and GFR. Conclusions: Changes in elasticity of the carotid artery is one of the earliest identifiable alterations in children with non-dialysis CKD but is primarily explained by level of blood pressure and not that of renal function.