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


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.


Kidney disease Children Aorta Arterial stiffness Pulse wave velocity Echocardiography 



Aorta or aortic


Aortic cross-sectional area


(Dd in Fig. 1) Aortic diameter in diastole


Aortic length


(Ds in Fig. 1) Aortic diameter in systole


Arterial wall stiffness index


Body mass index


Diastolic blood pressure


Systolic blood pressure


Body surface area


Blood urea nitrogen


Total calcium


Carotid artery intima-media thickness


Chronic kidney disease


Chronic kidney disease in children study


Elastic pressure-strain modulus


End-stage renal disease


Ejection time


Ejection time corrected for heart rate


Glomerular filtration rate




Interventricular septal thickness in diastole indexed to body surface area


Low density lipoprotein cholesterol


Natural logarithm


Left ventricular


Left ventricular end-diastolic dimension indexed to body surface area


Left ventricular end-systolic dimension indexed to body surface area


Left ventricular hypertrophy


Left ventricular mass indexed to body surface area


Mean velocity of circumferential fiber shortening corrected for heart rate


Peak systolic wall stress

π (pi)

Constant = 3.14


Peak aortic flow


Peak aortic velocity




Pulse pressure


Parathyroid hormone


Posterior wall thickness in diastole indexed to body surface area


Posterior wall thickness in systole indexed to body surface area


Pulse wave velocity

ρ (rho)

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


Serum creatinine


Shortening fraction


Total cholesterol




Transit time


Characteristic impedance


Input impedance


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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

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