Background

The peculiarity of the cardiovascular risk profile with increased arterial vulnerability is well known in adults with chronic kidney disease (CKD). It is explained by an increased incidence of traditional cardiovascular risk factors together with other comorbidities related to the uremic condition and cardiorenal syndrome (CRS). The present study aimed to determine the cardiovascular impact of the uremic condition in a pediatric population with advanced CKD.

Methods

From 2016 to 2018, 39 consecutive patients with advanced CKD who underwent echocardiographic evaluation were included. All echocardiographic examinations were performed by the same operator (FE). Demographic, clinical, biological, and echocardiographic data were collected.

Results

The mean age at echocardiographic exam was 9.7 ± 4.6 years. Twenty-four (61.5%) patients were on hemodialysis; 17 (43.6%) patients were in a peritoneal dialysis program of whom 11 switched at a later stage to hemodialysis. Eight (20.5%) patients had an arteriovenous fistula (AVF). Hypertension was present in 30 (76.9%) patients while left ventricular hypertrophy (LVH) was described in 13 (33.3%) patients. Dilatation of the ascending aorta (Z-score > 2) was found in 15 (38.4%) patients and was statistically (in univariate analysis) related to gender, hypertension, the presence of an AVF, and the use of hemodialysis after peritoneal dialysis (p = 0.024, p = 0.016, p = 0.006, p = 0.009, respectively).

Conclusion

In addition to classical and predictable abnormalities related to CKD, we found a high prevalence of dilatation of the ascending aorta in children with advanced CKD. Hypertension, AVF, and hemodialysis were associated factors.

Graphical abstract

中文翻译：

---

晚期慢性肾病患儿主动脉扩张

背景

在患有慢性肾病 (CKD) 的成年人中，心血管风险特征与动脉易损性增加是众所周知的。其原因是传统心血管危险因素的发病率增加以及与尿毒症和心肾综合征 (CRS) 相关的其他合并症。本研究旨在确定尿毒症对晚期 CKD 儿科人群的心血管影响。

方法

从 2016 年到 2018 年，连续纳入了 39 名接受超声心动图评估的晚期 CKD 患者。所有超声心动图检查均由同一操作员 (FE) 进行。收集人口统计学、临床、生物学和超声心动图数据。

结果

超声心动图检查的平均年龄为 9.7 ± 4.6 岁。24 名 (61.5%) 患者正在接受血液透析；17 名 (43.6%) 患者正在接受腹膜透析计划，其中 11 名患者在后期转为血液透析。8 名 (20.5%) 患者患有动静脉瘘 (AVF)。30 名 (76.9%) 患者出现高血压，而 13 名 (33.3%) 患者出现左心室肥厚 (LVH)。升主动脉扩张（Z 评分 > 2）见于 15 名（38.4%）患者，统计学（单变量分析）与性别、高血压、存在 AVF 和腹膜透析后使用血液透析有关（单变量分析）。p = 0.024、p = 0.016、p = 0.006、p = 0.009）。

结论

除了与 CKD 相关的经典和可预测的异常外，我们发现晚期 CKD 患儿升主动脉扩张的患病率很高。高血压、AVF 和血液透析是相关因素。

图形概要