Original Article

Pediatric Nephrology

, Volume 24, Issue 3, pp 555-563

First online:

Progression of coronary calcification in pediatric chronic kidney disease stage 5

  • Mahmut CivilibalAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical FacultyAtakoy 7–8.kısım, Mimar Sinan Sitesi Email author 
  • , Salim CaliskanAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty
  • , Sebuh KurugogluAffiliated withDepartment of Radiology, Istanbul University Cerrahpasa Medical Faculty
  • , Cengiz CandanAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty
  • , Nur CanpolatAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty
  • , Lale SeverAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty
  • , Ozgur KasapcopurAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty
  • , Nil ArisoyAffiliated withDepartment of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty

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Abstract

Coronary artery calcification (CAC) is common in adults with chronic kidney disease (CKD) and progresses with time. However, data are limited for younger patients. We have previously reported CAC in eight of 53 children with CKD. After 2 years, CAC evaluation was repeated in 48 patients. The median CAC score (CACS) increased from 101.3 (1473.6 ± 1978.6, range 8.5–4332) to 1759.2 (2236.4 ± 2463.3, range 0–5858) Agatston units (AU). When the individual changes in CACS were evaluated one by one, we showed a mild decrease in two patients on hemodialysis (HD) and in one transplant (Tx) recipient, a moderate increase in one patient on HD, one on peritoneal dialysis (PD) and one Tx recipient, and a large increase in one HD patient. Also, CAC disappeared in one HD patient. All patients with no calcification at baseline remained calcification-free at follow-up. To obtain the individual cumulative exposure, we calculated time-averaged mean values, using the laboratory values from the beginning of dialysis to the first and second multidetector spiral computed tomography (MDCT) scans (baseline and final values, respectively). Final CACS was positively related to final calcium–phosphorus (Ca×P) product, while CAC progression was inversely associated with final serum albumin level. This report is the first study with the largest number and the youngest cohort to document the natural history of coronary calcification.

Keywords

Child Young adult Coronary artery calcification Chronic kidney disease Dialysis Transplantation