Pediatric Cardiology

, Volume 34, Issue 5, pp 1218–1225

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

  • Mohammed Alghamdi
  • Astrid M. De Souza
  • Colin T. White
  • M. Terri Potts
  • Bradley A. Warady
  • Susan L. Furth
  • Thomas R. Kimball
  • James E. Potts
  • George G. S. Sandor
Original Article

DOI: 10.1007/s00246-013-0632-5

Cite this article as:
Alghamdi, M., De Souza, A.M., White, C.T. et al. Pediatr Cardiol (2013) 34: 1218. doi:10.1007/s00246-013-0632-5

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.

Keywords

Kidney diseaseChildrenAortaArterial stiffnessPulse wave velocityEchocardiography

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

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mohammed Alghamdi
    • 1
    • 2
  • Astrid M. De Souza
    • 1
  • Colin T. White
    • 3
  • M. Terri Potts
    • 1
  • Bradley A. Warady
    • 4
  • Susan L. Furth
    • 5
  • Thomas R. Kimball
    • 6
  • James E. Potts
    • 1
  • George G. S. Sandor
    • 1
    • 7
  1. 1.Division of Cardiology, Department of Pediatrics, British Columbia Children’s HospitalThe University of British ColumbiaVancouverCanada
  2. 2.Division of Pediatric Cardiology, King Fahad Cardiac CentreCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
  3. 3.Division of Nephrology, Department of Pediatrics, British Columbia Children’s HospitalThe University of British ColumbiaVancouverCanada
  4. 4.Division of Nephrology, Department of Pediatrics, Children’s Mercy HospitalThe University of Missouri-Kansas City School of MedicineKansas CityUSA
  5. 5.Division of Nephrology, Department of Pediatrics, Children’s Hospital of PhiladelphiaThe University of PennsylvaniaPhiladelphiaUSA
  6. 6.Division of Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical CenterThe University of CincinnatiCincinnatiUSA
  7. 7.Children’s Heart CentreVancouverCanada