Abstract
Cardiovascular disease (CVD) risk factors are present early in life in children with chronic kidney disease (CKD), consequently cardiovascular morbidity presents in early adulthood. However, risk factors of CVD have been rarely addressed in children with early stage of CKD. This study included 63 children and adolescents aged 8- to 18 years-old with CKD stage G1–G4. Cardiovascular assessments consisted of 24-h ambulatory blood pressure monitoring (ABPM), arterial stiffness index, and echocardiography. We also applied dual-energy x-ray absorptiometry (DXA) scanning to analyze percentage body fat (PBF), lean body mass index (LBMI), fat mass index (FMI), and the android to gynoid fat ratio (A/G ratio). Up to 63.5% of CKD children had abnormal changes in BP detected by ABPM. CKD children with abnormal ABPM were older, had higher numbers of CKD stage G2 to G4, hyperuricemia, obesity, and higher FMI z-score and A/G ratio compared to individuals with normal ABPM (all p < 0.05). Among these factors, only FMI z-score showed an independent association with abnormal ABPM using multivariate logistic regression analysis (p = 0.037). Our data highlight that body fat plays a key role for an abnormal ABPM in CKD children. The assessment of FMI may have clinical utility in discriminating CV risk in children and adolescents with early stages of CKD.
Highlights
Assessments, 63 children were grouped from this chronic kidney disease (CKD) cohort and defined as the dual-energy x-ray absorptiometry (DXA)
Our study revealed children with an abnormal ambulatory blood pressure monitoring (ABPM) were associated with several factors including age, CKD stage, hyperuricemia, obesity, fat mass index (FMI) z-score, and A/G ratio
Our results provide the first evidence to show that FMI is associated with CV risk represented by ABPM abnormalities in children with CKD in early stages
Summary
Patients with chronic kidney disease (CKD) exhibit a marked risk for cardiovascular (CV) comorbidities and mortality [1], whereas major CV events are uncommon in children with CKD [2]. Hypertension is an early sign of CVD and is the most common complication of childhood CKD [2]. Using 24-h ambulatory blood pressure monitoring (ABPM), we and others have shown that hypertension is present in more than one-half of children with CKD, which occurs even in early stages [3,4]. Subclinical CVD presenting in children is hardly detectable by conventional methods [5]. Left ventricle mass index (LVMI), ambulatory arterial stiffness index (AASI), and carotid intima-media thickness (cIMT) have been considered as surrogate markers for CVD in children with CKD [6,7,8]
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