Response to letter to the editor
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LETTER TO THE EDITORS
Response to letter to the editor Peace Madueme 1
&
Mark Mitsnefes 2
Received: 4 June 2020 / Revised: 23 June 2020 / Accepted: 25 June 2020 # IPNA 2020
Dear Editor, Our current article evaluated aortic dilatation in children with mild to moderate chronic kidney disease. Our retrospective analysis showed that markers of poor nutrition are associated with a higher prevalence of aortic dilatation. In response to our submission, a letter to the editor by Drs. Querfeld and Haffner suggested evaluating increased parathyroid hormone (iPTH) as it relates to aortic dilatation for added insight. We now provide the requested information by analyzing the association of iPTH with aortopathy in univariate and multivariable analyses. For those with no aortopathy, the median iPTH at baseline was 47.1 pg/mL [IQR 31.3, 67.6, n = 439], and for those with aortopathy, the median was 55.3 pg/mL [IQR 34.0, 75.4, n = 25], and these levels did not significantly differ by aortopathy status (p = 0.972). In univariate (unadjusted) analyses, for a one standard deviation (SD) increase in iPTH, the relative odds was 0.84 (95% CI 0.61, 1.16), and in a model adjusting for age, years with CKD, antihypertensive therapy, growth hormone use, and anemia, the relative odds was 0.81 (95% CI 0.61, 1.08); in both models, iPTH was not significantly associated with aortopathy. Table 1 displays the associations between a one SD increase iPTH (as a continuous independent variable) and the three z-scores as continuous outcomes (aortic root, aortic junction, and aortic ascending). In both univariate and multivariate models, no significant associations of iPTH with studied outcomes were found. Our results are consistent with two other CKiD studies examining vascular structure and function in children with chronic kidney disease (CKD). In the study by
* Peace Madueme [email protected] 1
Nemours duPont Pediatrics, Orlando, FL, USA
2
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Brady et al. [1], none of the markers of mineral bone disorder (MBD), including high iPTH, was associated with carotid artery intima-media thickness (cIMT). Hypertension and dyslipidemia were the only factors associated with increased cIMT. In another study by Savage et al. [2], pulse wave velocity (PWV) in children with CKD was similar to healthy controls. In their study, PWV increased significantly with age, mean arterial pressure, and black race with no other variables, including markers of MBD independently associated with PWV in multivariable analysis. There are a few possible reasons why our study did not observe significant associations of aortic dilatation with markers of MBD. First, levels of iPTH (and serum phosphorus) were relatively low and similar among those with and without aortopathy. Additionally, the participants in our study had relatively mild degree of CKD as the CKiD cohort enrolled patients only with CKD 2–4. Indeed, in our study, the median estimated glomerular filtration rate (eGFR) in children with aortopat
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