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Dyslipidemia, carotid intima-media thickness and endothelial dysfunction in children with chronic kidney disease

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Abstract

Background

Chronic kidney disease (CKD) predisposes to accelerated atherosclerosis that is measured by carotid artery intima-media thickness (cIMT) and brachial artery flow-mediated dilation (FMD). Information on the association of these parameters with dyslipidemia in pre-dialysis pediatric CKD is limited.

Methods

Eighty patients aged 9.9 ± 3.2 years, with estimated glomerular filtration rate of 38.8 ± 10.8 ml/1.73 m2/min, and 42 pediatric controls underwent cross-sectional analysis of lipid profile, cIMT, and brachial artery FMD. Significant differences in these parameters between patients and controls were analyzed using Student’s t test. Predictors of cIMT and dyslipidemia were assessed using linear and logistic regression respectively.

Results

Patients had elevated blood levels of triglyceride and of total and LDL cholesterol than controls (P ≤ 0.001); 73.8 % were dyslipidemic. Mean cIMT was higher (0.421 ± 0.054 mm vs 0.388 ± 0.036 mm, P = 0.001) and brachial artery FMD was reduced (10.6 ± 4.9 % vs 18.9 ± 4.1 %, P < 0.0001) in patients compared with controls. On multivariate analysis, hypertension (OR 3.68, P = 0.044) and male gender (OR 10.21, P = 0.004) were associated with dyslipidemia; cIMT was significantly associated with LDL cholesterol (β = 28.36, P = 0.033).

Conclusion

Dyslipidemia was prevalent and cIMT significantly elevated in pre-dialysis pediatric CKD, indicating increased cardiovascular risk. Elevated LDL cholesterol predicted increased cIMT, strengthening the association between dyslipidemia and atherosclerosis in early CKD.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Priyanka Khandelwal, Vijaya Murugan, Aditi Sinha, Pankaj Hari & Arvind Bagga

  2. Department of Radiology, All India Institute of Medical Sciences, New Delhi, India

    Smriti Hari

  3. Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India

    Ramakrishnan Lakshmy

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  1. Priyanka Khandelwal
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  2. Vijaya Murugan
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  3. Smriti Hari
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  4. Ramakrishnan Lakshmy
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  5. Aditi Sinha
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Correspondence to Pankaj Hari.

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This study was approved by the All India Institute of Medical Sciences Institute Ethics Committee (approval number AA­12/ 27. 02. 2009), and informed, written consent was obtained.

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The authors declare no conflicts of interest.

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Khandelwal, P., Murugan, V., Hari, S. et al. Dyslipidemia, carotid intima-media thickness and endothelial dysfunction in children with chronic kidney disease. Pediatr Nephrol 31, 1313–1320 (2016). https://doi.org/10.1007/s00467-016-3350-4

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  • DOI: https://doi.org/10.1007/s00467-016-3350-4

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