Aortic dilatation in children with mild to moderate chronic kidney disease
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ORIGINAL ARTICLE
Aortic dilatation in children with mild to moderate chronic kidney disease Peace C. Madueme 1 & Derek K. Ng 2 & Luke Guju 3 & Lauren Longshore 3 & Vicky Moore 3 & Lynn Jefferies 4 & Bradley A. Warady 5 & Susan Furth 6 & Mark Mitsnefes 3 Received: 8 August 2019 / Revised: 10 December 2019 / Accepted: 20 December 2019 # IPNA 2020
Abstract Background Children with mild to moderate chronic kidney disease are at an increased risk for cardiovascular sequelae, the leading cause of death in children with end-stage renal disease. We aimed to establish the prevalence of aortic dilatation, a newly recognized cardiovascular sequelae of renal disease, within a cohort of pediatric patients with mild to moderate kidney disease. Methods A total of 501 children enrolled in the Chronic Kidney Disease in Children study contributed imaging data between April 2011 and February 2015. Aortic dilatation was defined as a dimension exceeding a z-score of 2 at any of three locations: aortic root, sinotubular junction, or the ascending aorta. Results At baseline echocardiographic evaluation, 30 (6%) children were identified to have aortic dilatation in at least one of the three locations. Multivariate analysis demonstrated an increased odds ratio for the presence of aortic dilatation associated with the following variables: high diastolic blood pressure z-scores, low weight z-score, and low body mass index z-score. Presense of protein energy wasting (modified definition, OR 2.41, 95%CI 1.23, 4.70) was the strongest independent predictor of aortic dilatation. Conclusion In conclusion, aortic dilatation does occur early in the course of chronic kidney disease and associates with markers of poor nutrition. Future studies should continue to evaluate these risk factors longitudinally as the kidney disease progresses. Keywords Chronic kidney disease . Aortic dilatation . Cardiovascular disease . Protein energy wasting . Malnutrition
Introduction Chronic kidney disease (CKD) is a progressive life-long condition that is associated with significant morbidity and mortality. Cardiovascular disease is the leading cause of death in children with end-stage renal disease (ESRD) [1, 2]. We have recently reported that children on maintanence dialysis and
* Peace C. Madueme [email protected] 1
The Cardiac Center, Nemours Children’s Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
2
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
4
Methodist University of Tennessee Cardiovascular Institute, Memphis, TN, USA
5
Children’s Mercy Hospital, Kansas City, MO, USA
6
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
after kidney transplantation have dilatation of the proximal aortic dimensions, a previously unrecognized sequelae of ESRD [3]. Dilatation of aortic dimensions can be a precursor to aortic dissection and has been reported in association with other forms of kidney disease in adults [4]. Progressive aortic dilatation
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