Towards cardiovascular risks in children with chronic kidney disease: a prospective cohort study

Background: Children with chronic kidney disease (CKD) are at substantially high risk of morbidity and mortality from cardiovascular disease (CVD). Although this issue has been extensively studied in adults, little is known whether similar associations exist in the paediatric population. We therefore aimed to evaluate the cardiac structure and function in children with CKD, and investigate the factors that contribute to the development of CVD. Methods: : A prospective cohort was established following 40 children with CKD treated in the nephrology unit at a high-volume, tertiary, teaching hospital and compared to age- and gender-matched controls of the same number.  We reviewed the patients’ medical records, assessed growth parameters, measured blood pressure, took blood samples, and performed echocardiography. Results: : More than half of the CKD patients are hypertensive (N = 22; 55%) and were found to have a higher proportion of increased left ventricular mass index (LVMI) (75.5%; P = 0.001). In contrast, we did not find any significant association between CKD and both valvular calcification & left ventricular (LV) fractional shortening (FS) in children (P = 0.314). Furthermore, high LVMI is found to be correlated well with the following: anaemia, hypertension, CKD duration > one year, hyperparathyroidism, estimated glomerular filtration rate (eGFR) < 15ml/minute/1.73 m 2 and death (P < 0.05). Conclusions: : Despite the fact that LV systolic function is preserved and valvular calcification is usually absent, left ventricular hypertrophy (LVH) is common in children with CKD. Hypertension, anaemia, hyperparathyroidism, as well as the severity and duration of renal impairment, are amongst the additional risk factors that predispose to LVH. We contribute this study to the growing information of the review articles regarding the association between CKD and CVD in paediatrics.