Assessing Baseline Cardiovascular Disease for Kids Initiating Kidney Replacement Therapy: ABCD4Kids study

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https://storage.unitedwebnetwork.com/files/1099/20be34c3b75eda15812ca5089beb1714.pdf

Abstract Title

First Name *

Priyanka

Last Name *

Khandelwal

Co-author 1

Jonas Hofstetter jonas.hofstetter@med.uni-heidelberg.de Center for Pediatrics and Adolescent Medicine, University of Heidelberg Dept. of Pediatric Nephrology Heidelberg

Co-author 2

Claus Peter Schmitt ClausPeter.Schmitt@med.uni-heidelberg.de Center for Pediatrics and Adolescent Medicine, University of Heidelberg Dept. of Pediatric Nephrology Heidelberg

Co-author 3

Anette Melk melk.anette@mh-hannover.de Hannover Medical School Department of Kidney, Liver, and Metabolic Diseases Hannover

Co-author 4

Uwe Querfeld uwe.querfeld@charite.de Charite Children’s Hospital Dept. of Pediatric Nephrology Berlin

Co-author 5

Franz Schaefer franz.schaefer@med.uni-heidelberg.de Center for Pediatrics and Adolescent Medicine, University of Heidelberg Dept. of Pediatric Nephrology Heidelberg

Co-author 6

Rukshana Shroff Rukshana.Shroff@gosh.nhs.uk Great Ormond Street Hospital for Children NHS Foundation Trust, London Dept. of Pediatric Nephrology London

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Information on cardiovascular (CV) damage in children initiating kidney replacement therapy (KRT) is limited. We evaluated the CVD burden in incident dialysis and preemptive transplant recipients from two multicenter cohorts: the Cardiovascular Comorbidity in Childhood CKD (4C) and Haemodiafiltration, Heart and Height (3H) studies

Methods

Patients with CKD stage 4-5 approaching KRT were evaluated at three time points: median 2-yr, 1-yr and 35 days before KRT start. CV risk factors and structural (carotid intima-media thickness, cIMT-SDS, left ventricular mass index, LVMI) and functional (pulse wave velocity, PWV-SDS) CVD indices were measured at all time points

Results

248 incident KRT patients, median age 14 years, eGFR 12.2ml/min/1.73m2, 63% boys were studied. 82 (33%) were pre-emptively transplanted. At KRT initiation, pre-emptively transplanted patients had higher eGFR and lower 24-hr mean ambulatory BP, PWV-SDS and PTH compared to patients starting dialysis (P<0.001). Incident KRT patients had high CV burden: elevated cIMT-SDS and PWV-SDS in 43% and 25% respectively and LV hypertrophy in 49% (Fig). Accelerated aortic stiffness and LV hypertrophy was observed 1-yr and 2-yr prior to KRT onset, respectively (OR 3.3; P<0.001 and OR 4.3; P=0.04, Fig). Prevalence of structural vascular abnormalities significantly exceeded functional changes even 2-yr before KRT initiation (P<0.001). Increment in PWV-SDS was associated with cIMT-SDS in patients with cIMT SDS >2.5 (ꞵ=0.50; P=0.023). Increased diastolic BP SDS and body mass index (BMI) were independently associated with change in all CV measures: cIMT SDS (ß=0.15, P=0.013; ß=0.15, P=0.021), LVMI (ß=1.27, P=0.04; ß=1.7, P=0.013) and PWV-SDS (ß=0.14, P=0.044; ß=0.20, P=0.008), respectively. Additional independent predictors were iPTH (cIMT), low bicarbonate, low serum albumin, systolic BP (LVMI) and high LDL-C and low serum albumin (PWV-SDS)

Conclusions

Patients with advanced CKD approaching KRT have a high burden of CVD. Early structural changes progress to functional damage in the thickest of vessels. Aortic stiffness and associated LV hypertrophy progress rapidly 1-2 yr prior to KRT initiation. Early intervention to manage modifiable risk factors predicting CVD is essential

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