Aortic dilatation in children with mild to moderate chronic kidney disease

• Published in: Pediatric nephrology (Berlin, West) Vol. 35; no. 6; pp. 1023 - 1031
• Main Authors: Madueme, Peace C., Ng, Derek K., Guju, Luke, Longshore, Lauren, Moore, Vicky, Jefferies, Lynn, Warady, Bradley A., Furth, Susan, Mitsnefes, Mark
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2020; Springer; Springer Nature B.V
• Subjects: Adolescent; Aorta; Aortic Diseases - epidemiology; Aortic Diseases - etiology; Aortic Diseases - pathology; Blood pressure; Body mass index; Cardiovascular diseases; Care and treatment; Case-Control Studies; Child; Children; Complications; Complications and side effects; Dilatation, Pathologic; Disease Progression; Diseases; Echocardiography - methods; End-stage renal disease; Female; Health risk assessment; Heart Disease Risk Factors; Humans; Kidney diseases; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Multivariate analysis; Nephrology; Original Article; Pediatrics; Prevalence; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Retrospective Studies; Risk factors; Statistics; Urology; What’s New in Chronic Kidney Disease; United States; Aortic dilatation; Cardiovascular disease; Chronic kidney disease; Malnutrition; Protein energy wasting
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-019-04469-3

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.