Large vessel disease in children with chronic kidney disease

Objectives: To assess early atherosclerotic changes using echocardiography and to correlate with the clinical and biochemical parameters associated with chronic kidney disease (CKD).

Method A cross sectional study was carried out in a tertiary care hospital over a period of 2 years. All 45 children with CKD registered with the nephrology unit were assessed and 43 without congenital cardiac disease were included. Data regarding onset of CKD, stage of CKD, biochemical profile and carotid intima-media thickness (CIMT) measured by B-mode echocardiography were analysed in these children. Correlation of CIMT with the stage of CKD, biochemical and clinical parameters associated with CKD was the main outcome measured.

Results: Ninety percent of the patients had high CIMT. The mean CIMT was more in children with end stage renal disease (ESRD) (0.139±0.009cm vs 0.112±0.007cm; p = 0.003). There was a significant difference between the mean CIMT in normotensive patients (0.104±0.008cm) and well controlled systolic and diastolic hypertension [(0.134±0.009cm) and (0.132±0.009cm) respectively]. Mean CIMT in children with uncontrolled systolic and diastolic hypertension group (0.152±0.009cm) was higher as compared to the mean CIMT in patients well controlled hypertension and normotensive patients (0.116±0.006cm; p=0.0214).

Conclusions: CIMT is an echocardiographic marker for cardiovascular disease in CKD. Hypertension is the single most important risk factor associated with large vessel disease.

Sri Lanka Journal of Child Health, 2019; 48(2): 127-133