The authors reply

Abstract

We acknowledge the points made by Sepe et al. regarding a potential role for dialysis modality in moderating arterial damage. 1 Sepe V. Rampino T. Libetta C. Arterial "inflammaging" drives vascular calcification in children on dialysis. Kidney Int. 2019; 96: 522 Scopus (5) Google Scholar To clarify, our study was a concept paper, and we clearly state the limitations regarding the small number of patient samples we were able to utilize. 2 Sanchis P. Ho C.Y. Liu Y. et al. Arterial "inflammaging" drives vascular calcification in children on dialysis. Kidney Int. 2019; 95: 958-972 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar The study included 24 children on dialysis, 14 on peritoneal dialysis, and 10 on hemodialysis. The median age was 14.3 years, and the median time on dialysis was 1.9 years, with no significant difference between groups. None of the children had underlying inflammatory diseases or infections in the 6 weeks preceding vessel collection. Biocompatible dialysers and ultrapure water for hemodialysis and biocompatible solutions for peritoneal dialysis were routinely used. In previous work in a larger cohort of children on dialysis, we showed that there was no difference in clinical measures of vascular calcification (i.e., carotid intima media thickness, pulse wave velocity, or coronary calcification on CT scan) 3 Shroff R.C. Donald A.E. Hiorns M.P. et al. Mineral metabolism and vascular damage in children on dialysis. J Am Soc Nephrol. 2007; 18: 2996-3003 Crossref PubMed Scopus (171) Google Scholar or on vessel calcium load 4 Shroff R.C. McNair R. Figg N. et al. Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation. 2008; 118: 1748-1757 Crossref PubMed Scopus (395) Google Scholar with respect to dialysis modality. The authors allude to reduced inflammation with vitamin E–coated dialysers, but these dialysers are not available in pediatric sizes, and there are no studies that have conclusively shown their benefit in adults on hemodialysis. Regarding the role of immune senescence—in the context of medial vascular calcification in children, in which there are very few inflammatory cells within the vessel wall, our study highlights a role for sterile inflammation emanating from senescent vascular cells as a novel component of inflammaging. Arterial "inflammaging" drives vascular calcification in children on dialysisKidney InternationalVol. 96Issue 2PreviewSanchis et al.1 reported interesting data on the association between vascular calcification and arterial inflammaging in children with advanced chronic kidney disease. We agree that uremic children are a potentially ideal model for studying accelerated cellular senescence, but the authors do not differentiate between those on hemodialysis and those on peritoneal dialysis therapy. Peritoneal dialysis is known to be characterized by a generally superior biocompatibility compared with hemodialysis. Full-Text PDF Arterial “inflammaging” drives vascular calcification in children on dialysisKidney InternationalVol. 95Issue 4PreviewChildren on dialysis have a cardiovascular mortality risk equivalent to older adults in the general population, and rapidly develop medial vascular calcification, an age-associated pathology. We hypothesized that premature vascular ageing contributes to calcification in children with advanced chronic kidney disease (CKD). Vessels from children with Stage 5 CKD with and without dialysis had evidence of increased oxidative DNA damage. The senescence markers p16 and p21 were also increased in vessels from children on dialysis. Full-Text PDF Open Access