Educational Review

Pediatric Nephrology

, Volume 28, Issue 6, pp 875-884

First online:

Cardiovascular risk assessment in children with chronic kidney disease

  • Rukshana ShroffAffiliated withRenal Unit, Great Ormond Street Hospital for Children
  • , Arianna DégiAffiliated withFirst Department of Pediatrics, Semmelweis University
  • , Andrea KertiAffiliated withFirst Department of Pediatrics, Semmelweis University
  • , Éva KisAffiliated withFirst Department of Pediatrics, Semmelweis University
  • , Orsolya CseprekálAffiliated withFirst Department of Internal Medicine, Semmelweis University
  • , Kálmán ToryAffiliated withFirst Department of Pediatrics, Semmelweis University
  • , Attila J. SzabóAffiliated withFirst Department of Pediatrics, Semmelweis University
  • , George S. ReuszAffiliated withFirst Department of Pediatrics, Semmelweis University Email author 

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Chronic kidney disease (CKD) is a major factor contributing to cardiovascular (CV) morbidity and mortality with the highest risk in patients on dialysis. An estimation of CV risk is important not only to identify potential modifiable risk factors but also to evaluate the effect of treatments aimed to reduce the risk. Non-invasive methods of measuring vascular changes and circulating biomarkers are available to assess the presence and severity of cardiovascular damage. These include measures of structural (carotid intima-media thickness and coronary artery calcification score) and functional (aortic pulse wave velocity, 24-h ambulatory blood pressure monitoring, ambulatory arterial stiffness index, heart rate variability and flow-mediated dilatation) changes in the vessel wall. In addition, a number of circulating biomarkers of vascular damage and its progression have been studied. Many of these tests are well validated as surrogate markers of future cardiovascular events and death in adult CKD patients, but need technical adaptation, standardization and validation for use in children. With our current state of knowledge, these are best reserved for research studies and scarce clinical resources may be better utilized for preventative strategies to reduce the modifiable risk factors for calcification from early CKD stages.


Chronic kidney disease Cardiovascular disease Carotid intima-media thickness Pulse wave velocity Biomarkers