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Echo-Doppler Assessment of the Biophysical Properties of the Aorta in Children With Chronic Kidney Disease

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Abstract

Chronic kidney disease (CKD) is known to cause increased arterial stiffness, which is an important independent risk factor for adverse cardiovascular events. The purpose of this study was to assess the vascular properties of the aorta (AO) in a group of children with CKD using a noninvasive echocardiography (echo)-Doppler method. We studied 24 children with stages 2 through 5 CKD and 48 age-matched controls. Detailed echocardiographic assessment and echo-Doppler pulse wave velocity (PWV) was performed. Indices of arterial stiffness, including characteristic (Zc) and input (Zi) impedances, elastic pressure-strain modulus (Ep), and arterial wall stiffness index, were calculated. CKD patients underwent full nephrology assessment, and an iohexol glomerular filtration rate was performed, which allowed for accurate assignment of the CKD stage. CKD patients had greater median systolic blood pressure (114 vs. 110 mmHg; p < 0.04) and pulse pressure (51 vs. 40 mmHg; p < 0.001) compared with controls. PWV was similar between groups (358 vs. 344 cm s−1; p = 0.759), whereas Zi (182 vs. 131 dyne s cm−5; p < 0.001), Zc (146 vs. 138 dyne s cm−5; p = 0.05), and Ep (280 vs. 230 mmHg; p < 0.02) were significantly greater in CKD than in controls. Although load-dependent measures of arterial stiffness were greater in non-dialysis dependent CKD patients, PWV was not increased compared with controls. This suggests that the increased arterial stiffness may not be permanent in these pediatric patients with kidney disease.

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Abbreviations

AO:

Aorta or aortic

AOcsa:

Aortic cross-sectional area

AOD:

(Dd in Fig. 1) Aortic diameter in diastole

AOL:

Aortic length

AOS:

(Ds in Fig. 1) Aortic diameter in systole

β-index:

Arterial wall stiffness index

BMI:

Body mass index

BPdia:

Diastolic blood pressure

BPsys:

Systolic blood pressure

BSA:

Body surface area

BUN:

Blood urea nitrogen

Ca-T:

Total calcium

cIMT:

Carotid artery intima-media thickness

CKD:

Chronic kidney disease

CKiD:

Chronic kidney disease in children study

Ep:

Elastic pressure-strain modulus

ESRD:

End-stage renal disease

ET:

Ejection time

ETc:

Ejection time corrected for heart rate

GFR:

Glomerular filtration rate

Hb:

Hemoglobin

IVSDi:

Interventricular septal thickness in diastole indexed to body surface area

LDL-C:

Low density lipoprotein cholesterol

Ln:

Natural logarithm

LV:

Left ventricular

LVEDi:

Left ventricular end-diastolic dimension indexed to body surface area

LVESi:

Left ventricular end-systolic dimension indexed to body surface area

LVH:

Left ventricular hypertrophy

LVMassi:

Left ventricular mass indexed to body surface area

MVCFc:

Mean velocity of circumferential fiber shortening corrected for heart rate

σPS:

Peak systolic wall stress

π (pi):

Constant = 3.14

PkAOFlow:

Peak aortic flow

PkAOV:

Peak aortic velocity

PO4 :

Phosphate

PP:

Pulse pressure

PTH:

Parathyroid hormone

PWDi:

Posterior wall thickness in diastole indexed to body surface area

PWSi:

Posterior wall thickness in systole indexed to body surface area

PWV:

Pulse wave velocity

ρ (rho):

Blood density = 1.06 g cm−5, 1 dyne = 1 g cm−2 s−1

SCr:

Serum creatinine

SF:

Shortening fraction

TC:

Total cholesterol

TG:

Triglycerides

TT:

Transit time

Zc:

Characteristic impedance

Zi:

Input impedance

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Acknowledgments

The CKiD Study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases with additional funding from the National Institute of Neurologic Disorders and Stroke; the National Institute of Child Health and Human Development; and the National Heart, Lung, and Blood Institute (Grants No. UO1-DK-66143, UO1-DK-66174, UO1-DK-66116, and U01-DK-082194). GE Health Care, Amersham Division, provided iohexol for the GFR measurements. The CKID web site is located at http://www.statepi.jhsph.edu/ckid. We thank Josephine Chow for invaluable assistance in coordinating all of the CKiD investigations locally.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada

    Mohammed Alghamdi, Astrid M. De Souza, M. Terri Potts, James E. Potts & George G. S. Sandor

  2. Division of Pediatric Cardiology, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Mohammed Alghamdi

  3. Division of Nephrology, Department of Pediatrics, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada

    Colin T. White

  4. Division of Nephrology, Department of Pediatrics, Children’s Mercy Hospital, The University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Bradley A. Warady

  5. Division of Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA, USA

    Susan L. Furth

  6. Division of Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, The University of Cincinnati, Cincinnati, OH, USA

    Thomas R. Kimball

  7. Children’s Heart Centre, 4480 Oak Street, Room 1C49, Vancouver, BC, V6H 3V4, Canada

    George G. S. Sandor

Authors
  1. Mohammed Alghamdi
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  2. Astrid M. De Souza
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  3. Colin T. White
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  4. M. Terri Potts
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  5. Bradley A. Warady
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  6. Susan L. Furth
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  7. Thomas R. Kimball
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  8. James E. Potts
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  9. George G. S. Sandor
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Corresponding author

Correspondence to George G. S. Sandor.

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Alghamdi, M., De Souza, A.M., White, C.T. et al. Echo-Doppler Assessment of the Biophysical Properties of the Aorta in Children With Chronic Kidney Disease. Pediatr Cardiol 34, 1218–1225 (2013). https://doi.org/10.1007/s00246-013-0632-5

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  • DOI: https://doi.org/10.1007/s00246-013-0632-5

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