Vascular Damage in Children With Chronic Kidney Disease

See related article, pp 863–869

Children with chronic kidney disease (CKD) have an increased mortality risk during childhood and as a young adult. Precisely, the lifespan of a pediatric patient on dialysis is shortened by 50 years compared with that of control individuals, matched for age and ethnicity.¹ Children with end-stage renal disease have a 10-year survival rate of ≈80% and an age-specific mortality rate of ≈30× that seen in children without end-stage renal disease.² In spite of a lower exposure to classical risk factors (diabetes mellitus, smoking, and hyperlipidemia), the most common cause of death in these children is cardiovascular disease. Hypertension, alterations in mineral metabolism, anemia, or chronic inflammation may explain part of this increased cardiovascular risk. In adults with CKD, increased aortic stiffness may lead to left ventricular hypertrophy and left ventricular dysfunction and is an important independent predictor of future cardiovascular events and mortality.

In children with moderate to severe CKD, there are fewer reports showing that arterial stiffness may contribute to cardiovascular morbidity or mortality. In addition, carotid-femoral pulse wave velocity (cfPWV) assessed by applanation tonometry—the most commonly used measure of arterial stiffness—may be challenging to measure, especially in younger children, because it is time-consuming and require patient collaboration.³ Finally, even if the patient is cooperative, it can be more difficult to maintain a sufficiently strong signal from the smaller arteries of younger children. It also requires a trained operator and access to the femoral artery in the inguinal area—a potentially disturbing maneuver, particularly in adolescents. Oscillometric assessment of pulse wave velocity (PWV) using a pressure cuff has the advantages of being quick, convenient, and operator independent.³

In the last 10 years, …