1. Findings from 4C-T Study demonstrate an increased cardiovascular burden in girls with end stage kidney disease and kidney transplantation
- Author
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Rizky I. Sugianto, Nima Memaran, Bernhard M.W. Schmidt, Anke Doyon, Daniela Thurn-Valsassina, Harika Alpay, Ali Anarat, Klaus Arbeiter, Karolis Azukaitis, Aysun K. Bayazit, Ipek K. Bulut, Salim Caliskan, Nur Canpolat, Ali Duzova, Jutta Gellerman, Jerome Harambat, Denise Homeyer, Mieczyslaw Litwin, Francesca Mencarelli, Lukasz Obrycki, Dusan Paripovic, Bruno Ranchin, Rukshana Shroff, Uwe Tegtbur, Jeannine von der Born, Ebru Yilmaz, Uwe Querfeld, Elke Wühl, Franz Schaefer, Anette Melk, Sugianto, Rizky I., Memaran, Nima, Schmidt, Bernhard M. W., Doyon, Anke, Thurn-Valsassina, Daniela, Alpay, Harika, Anarat, Ali, Arbeiter, Klaus, Azukaitis, Karolis, Bayazit, Aysun K., Bulut, Ipek K., Caliskan, Salim, Canpolat, Nur, Duzova, Ali, Gellerman, Jutta, Harambat, Jerome, Homeyer, Denise, Litwin, Mieczyslaw, Mencarelli, Francesca, Obrycki, Lukasz, Paripovic, Dusan, Ranchin, Bruno, Shroff, Rukshana, Tegtbur, Uwe, Born, Jeannine von der, Yilmaz, Ebru, Querfeld, Uwe, Wühl, Elke, Schaefer, Franz, and Melk, Anette
- Subjects
Adult ,Male ,sex differences ,Risk ,pulse wave velocity ,Pulse-Wave Velocity ,Blood Pressure ,Pulse Wave Analysis ,Vascular Stiffness ,Age ,children ,arterial stiffness ,arteriosclerosis ,cardiovascular disease ,chronic kidney disease ,glomerular filtration rate ,kidney function decline ,pediatric kidney transplantation ,prospective study ,Reference Values ,risk factors ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,Mortality ,Child ,Healthy-Children ,transplant outcomes ,Gender ,Kidney Transplantation ,Nephrology ,Blood-Pressure ,Disease Progression ,Kidney Failure, Chronic ,Female ,Renal-Disease - Abstract
Mortality in children with kidney failure is higher in girls than boys with cardiovascular complications representing the most common causes of death. Pulse wave velocity (PWV), a measure of vascular stiffness, predicts cardiovascular mortality in adults. Here, PWV in children with kidney failure undergoing kidney replacement therapy was investigated to determine sex differences and potential contributing factors. Two-hundred thirty-five children (80 girls; 34%) undergoing transplantation (150 pre-emptive, 85 with prior dialysis) having at least one PWV measurement pre-and/or post-transplantation from a prospective cohort were analyzed. Longitudinal analyses (median/maximum followup time of 6/9 years) were performed for PWV z-scores (PWVz) using linear mixed regression models and further stratified by the categories of time: pre-kidney replacement therapy and post-transplantation. PWVz significantly increased by 0.094 per year and was significantly higher in girls (PWVz + 0.295) compared to boys, independent of the underlying kidney disease. During pre-kidney replacement therapy, an average estimated GFR decline of 4 ml/min/1.73 m(2) per year was associated with a PWVz increase of 0.16 in girls only. Higher diastolic blood pressure and low density lipoprotein were independently associated with higher PWVz during pre-kidney replacement therapy in both sexes. In girls post-transplantation, an estimated GFR decline of 4ml/min/1.73m(2) per year pre-kidney replacement therapy and a longer time (over 12 months) to transplantation were significantly associated with higher PWVz of 0.22 and of 0.57, respectively. PWVz increased further after transplantation and was positively associated with time on dialysis and diastolic blood pressure in both sexes. Thus, our findings demonstrate that girls with advanced chronic kidney disease are more susceptible to develop vascular stiffening compared to boys, this difference persist after transplantation and might contribute to higher mortality rates seen in girls with kidney failure., German Federal Ministry of Education and Research [01EO0802]; European Renal Association -European Dialysis and Transplant Association; Roche Organ Transplant Research Foundation [365520785], This study was made possible by grants from the German Federal Ministry of Education and Research (#01EO0802), the European Renal Association -European Dialysis and Transplant Association (www.eraedta.org), and Roche Organ Transplant Research Foundation (#365520785). Several coauthors are members of the European Rare Kidney Disease Reference Network (ERKNet). This study has been presented as an abstract at the TTS (The Transplantation Society) 2020 Virtual Congress on September 14, 2020.
- Published
- 2022