Pulse Wave Velocity as a Marker of Vascular Dysfunction and Its Correlation with Cardiac Disease in Children with End-Stage Renal Disease (ESRD).

Cristina Filip,Elena Camelia Berghea,Marcela Daniela Ionescu,Cătălin Cirstoveanu,Mihaela Bizubac,Alin Nicolescu,Mihaela Bălgrădean,Andrei Căpitănescu,Carmen Pavelescu

doi:10.3390/diagnostics12010071

Abstract

One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.

Highlights

The main leading cause of death in end-stage renal disease (ESRD) is cardiovascular disease (CVD) [1,2]
Left ventricular (LV) abnormalities such as LV hypertrophy (LVH) and LV dysfunction, damage to the large arteries such as arterial stiffness, increased intima-medial thickness (IMT) of the carotids, and coronary/carotid calcifications are accepted as early markers of cardiomyopathy and atherosclerosis
This study shows that vascular stiffness in children with chronic kidney disease (CKD) based on increased pulse wave velocity (PWV) is signiffiicantly correlated with the presence of cardiac impairment, deffiined as the presence of LVVccoonncceennttrriiccrreemmooddeelliinnggoorrhhyyppeerrttrroopphhyy

Summary

Introduction

The main leading cause of death in end-stage renal disease (ESRD) is cardiovascular disease (CVD) [1,2]. The presence of cardiomyopathy (left ventricle hypertrophy/remodeling), as well as early signs of atherosclerosis (increased values of the carotid artery intima-media thickness, arterial stiffness), are very often present in children with CKD, and especially in children who are treated with dialysis [3]. Left ventricular (LV) abnormalities such as LV hypertrophy (LVH) and LV dysfunction, damage to the large arteries such as arterial stiffness, increased intima-medial thickness (IMT) of the carotids, and coronary/carotid calcifications are accepted as early markers of cardiomyopathy and atherosclerosis. These markers are strong, independent predictors of cardiac morbidity and mortality, in children with CKD [10]. CVD was described as the cause of death in children with CKD in 23% compared with 3% in the general pediatric population [11]

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