RISK FACTORS FOR CARDIOVASCULAR COMPLICATIONS IN CHILDREN WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract

THE AIM:to identify the frequency and risk factors of cardiovascular lesions in children with ADPKD.PATIENTS AND METHODS:54 children (27M/27F) with ADPKD were examined. The median age was 12 (IQR: 8.0;15.0) years. Standard two-dimensional echocardiogram was performed. LV mass (LVM) was calculated, normalized to height2.7 and estimated by centile tables. Relative wall thickness (RWT) was calculated. Patterns of abnormal LV geometry were defined as follows: LV concentric remodelling by normal LVMI and RWT ≥0.42; eccentric LV hypertrophy (LVH) by increased LVMI and RWT <0.42; concentric LVH by increased LVMI and RWT ≥0.42. We checked blood pressure with ABPM. Patients were divided into 3 groups according to three levels of BP: hypertension (HBP; greater than the 95th percentile for sex, age, and height), high normal blood pressure (HNBP; 90–95th percentile), and normotension (NBP; less than the 90th percentile). Total kidney volume (cm3) was assessed by ultrasound, corrected for standard body surface and estimated by centile tables. Renal scintigraphy with 99mTc-dimercaptosuccinic acid (DMSA) with the calculation of the integral index of capture (IIC) was performed.RESULTS:Hypertension was found in 42,5 % of cases, HNBP was in 18,5% of cases. HBP were detected more frequently in children with increased renal volume (cm3/1,73m2) more than 97‰+≥50% compared with children with renal volume less than 97‰: (p=0.03), RR=2.9 (95% CI:1.4-4.9). Changes in the structure and geometry of the LV were identified in 14.8% of cases (concentric LVH – 7,4%; eccentric LVH -3,7%; LV concentric remodeling -3,7%). Children with LVMI >90 percentile were more frequently detected systolic hypertension in the daytime, diastolic hypertension at night compared with children with LVMI <90 percentile: 54% vs. 18% (p=0.04), RR=1.81 (95% CI:0.93-3.5) and 55% vs. 16% (p=0.008), RR=2.2 (95% CI:0.98-4.6). LVMI in children with systolic and diastolic hypertension was significantly higher than in children with isolated diastolic hypertension: 34.15 (30.7; 39) vs. 22.77 (22.04; 23.5) (p = 0.03). Increased renal volume (cm3/1,73m2) more than 97‰ and decreased IIC by DMSA were detected more frequently in children with LVMI>90 percentile compared with children with LVMI <90 percentile: (p=0.04), RR=1.7 (95% CI:1.1-2.6) and (р=0.04), RR=1.8 (95% CI:1.1-3.07).CONCLUSION:Risk factor for hypertension in children with ADPKD is increased renal volume. Risk factors for the development of left ventricular hypertrophy are systolic hypertension in the daytime, diastolic hypertension at night, increased kidney volume, and decreased IIC by DMSA.