A comprehensive study of cardiovascular risk factors, cardiac function and vascular disease in children with chronic renal failure.

BACKGROUND Cardiovascular disease causes major morbidity and is an important determinant of premature death in the paediatric chronic kidney disease (CKD) population. It is composed of three separate, although interrelated, disease processes: atherosclerosis, arteriosclerosis (i.e. medial vascular calcifications) and myocardial disease. Myocardial consequences of atherosclerosis barely exist in children, thus providing a good opportunity to investigate the role that kidney disease plays in the development of cardiovascular disease. METHODS We assessed 70 patients, aged 4 months to 18 years, with chronic kidney disease stages 3-5, for known risk factors of cardiovascular disease and for additional laboratory and clinical variables which may have an impact on this disease process. Carotid artery ultrasound was used to evaluate vascular structure and function, whereas myocardial disease was assessed by echocardiography. RESULTS Traditional risk factors, although present in this cohort, did not accumulate with progression of chronic kidney disease. Non-traditional risk factors increased in number and severity in correlation with the stage of CKD. The main myocardial abnormalities were left ventricular hypertrophy and diastolic dysfunction. Vascular function tests correlated with calcium-phosphate metabolism variables, homocysteine and time-averaged serum uric acid. CONCLUSIONS This study shows that children with CKD are exposed to risk factors and demonstrate signs of cardiovascular disease already at a young age. The possible role of uric acid and homocysteine in the evolution of cardiovascular disease is discussed. Further studies looking at possible interventions to prevent cardiovascular morbidity and mortality in this high risk population are needed.