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

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 disease Children Aorta Arterial stiffness Pulse wave velocity Echocardiography 

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

References

  1. 1.
    Bradley TJ, Potts JE, Potts MT, De Souza AM, Sandor GGS (2005) Echocardiographic Doppler assessment of the biophysical properties of the aorta in pediatric patients with the Marfan syndrome. Am J Cardiol 96:1317–1321PubMedCrossRefGoogle Scholar
  2. 2.
    Bradley TJ, Potts JE, Lee SK, Potts MT, De Souza AM, Sandor GGS (2009) Early changes in the biophysical properties of the aorta in pre-adolescent children born small for gestational age. J Pediatr 156:388–392PubMedGoogle Scholar
  3. 3.
    Briese S, Claus M, Querfeld U (2008) Arterial stiffness in children after renal transplantation. Pediatr Nephrol 23:2241–2245PubMedCrossRefGoogle Scholar
  4. 4.
    Charakida M, Deanfield JE, Halcox JP (2007) Childhood origins of arterial disease. Curr Opin Pediatr 19:538–545PubMedCrossRefGoogle Scholar
  5. 5.
    Covic AP, Gusbeth-Tatomir P, Goldsmith DJ (2005) Arterial stiffness in renal patients: an update. Am J Kidney Dis 45:965–977PubMedCrossRefGoogle Scholar
  6. 6.
    Covic A, Mardare N, Gusbeth-Tatomir P, Brumaru O, Gavrilovici C, Munteanu M et al (2006) Increased arterial stiffness in children on haemodialysis. Nephrol Dial Transplant 21:729–735PubMedCrossRefGoogle Scholar
  7. 7.
    Daniels SR, Greer FR (2008) Lipid screening and cardiovascular health in childhood. Pediatrics 122:198–208PubMedCrossRefGoogle Scholar
  8. 8.
    Edwards NC, Steeds RP, Stewart PM, Ferro CJ, Townend JN (2009) Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: a randomized controlled trial. J Am Coll Cardiol 54:505–512PubMedCrossRefGoogle Scholar
  9. 9.
    Guerin AP, Pannier B, Metivier F, Marchais SJ, London GM (2008) Assessment and significance of arterial stiffness in patients with chronic kidney disease. Curr Opin Nephrol Hypertens 17:635–641PubMedCrossRefGoogle Scholar
  10. 10.
    Hansen TW, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H et al (2006) Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 113:664–670CrossRefGoogle Scholar
  11. 11.
    Jo CO, Lande MB, Meagher CC, Wang H, Vermilion RP (2010) A simple method of measuring thoracic aortic pulse wave velocity in children: methods and normal values. J Am Soc Echocardiogr 23:735–740PubMedCrossRefGoogle Scholar
  12. 12.
    Kiotsekoglou A, Moggridge JC, Saha SK, Kapetanakis V, Govindan M, Alpendurada F et al (2011) Assessment of aortic stiffness in Marfan syndrome using two-dimensional and Doppler echocardiography. Echocardiography 28:29–37PubMedCrossRefGoogle Scholar
  13. 13.
    Kis E, Cseprekal O, Horvath Z, Datona G, Fekete B, Hrapka E et al (2008) Pulse wave velocity in end-stage renal disease: influence of age and body dimensions. Pediatr Res 63:95–98PubMedCrossRefGoogle Scholar
  14. 14.
    Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM et al (2006) Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 19:1413–1430PubMedCrossRefGoogle Scholar
  15. 15.
    Laurent S (2008) Aortic, carotid and femoral stiffness: how do they relate? Towards reference values. J Hypertens 26:1305–1306PubMedCrossRefGoogle Scholar
  16. 16.
    Laurent S, Boutouyrie P (2007) Arterial stiffness: a new surrogate end point for cardiovascular disease? J Nephrol 20:S45–S50PubMedGoogle Scholar
  17. 17.
    Laurent S, Cockcroft J, Van Ortel L, Boutouyrie P, Giannattasio C, Hayoz D et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605PubMedCrossRefGoogle Scholar
  18. 18.
    Levin A (2003) Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 16:101–105PubMedCrossRefGoogle Scholar
  19. 19.
    Lilien MR, Groothoff JW (2009) Cardiovascular disease in children with CKD or ESRD. Nat Rev Nephrol 5:229–235PubMedCrossRefGoogle Scholar
  20. 20.
    London GM, Marchais SJ, Guerin AP, Pannier B (2004) Arterial stiffness: pathophysiology and clinical impact. Clin Exp Hypertens 26:689–699PubMedCrossRefGoogle Scholar
  21. 21.
    Mallareddy M, Parikh CR, Peixoto AJ (2006) Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens 8:398–403CrossRefGoogle Scholar
  22. 22.
    Mattace-Raso FUS, van der Cammen TJM, Hofman A, van Popele NM, Bos ML, Schalekamp MADH et al (2006) Arterial stiffness and risk of coronary heart disease and stroke. Circulation 113:657–663PubMedCrossRefGoogle Scholar
  23. 23.
    Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR et al (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 16:2796–2803PubMedCrossRefGoogle Scholar
  24. 24.
    Oliver JJ, Webb DJ (2003) Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol 23:554–566PubMedCrossRefGoogle Scholar
  25. 25.
    Paoletti E, Bellino D, Cassottana P, Rolla D, Cannella G (2005) Left ventricular hypertrophy in nondiabetic predialysis CKD. Am J Kidney Dis 46:320–327PubMedCrossRefGoogle Scholar
  26. 26.
    Patrianakos AP, Karakitsos DN, de Groot E, Parthenakis FI, Daphnis EK, Vardas PE (2006) Alteration of proximal aorta biophysical properties in patients with end stage renal disease. Heart 92:228–232PubMedCrossRefGoogle Scholar
  27. 27.
    Querfeld U (1993) Disturbances of lipid metabolism in children with chronic renal failure. Pediatr Nephrol 7:749–757PubMedCrossRefGoogle Scholar
  28. 28.
    Safar ME, London GM, Plante GE (2004) Arterial stiffness and kidney function. Hypertension 43:163–168PubMedCrossRefGoogle Scholar
  29. 29.
    Saland JM, Ginsberg H, Fisher EA (2002) Dyslipidemia in pediatric renal disease: epidemiology, pathophysiology, and management. Curr Opin Pediatr 14:197–204PubMedCrossRefGoogle Scholar
  30. 30.
    Sandor GGS, Hishitani T, Petty RE, Potts MT, De Souza A, De Souza E et al (2003) A novel Doppler echocardiographic method of measuring the biophysical properties of the aorta in pediatric patients. J Am Soc Echocardiogr 16:745–750PubMedCrossRefGoogle Scholar
  31. 31.
    Schwartz GJ, Furth S, Cole S, Warady B, Munoz A (2006) Glomerular filtration rate via plasma iohexol disappearance: pilot study for chronic kidney disease in children. Kidney Int 69:2070–2077PubMedCrossRefGoogle Scholar
  32. 32.
    Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedCrossRefGoogle Scholar
  33. 33.
    Sugawara J, Hayashi K, Yokoiand T, Tanaka H (2010) Carotid-femoral pulse wave velocity: impact of different arterial path length measurements. Artery Res 4:27–31PubMedCrossRefGoogle Scholar
  34. 34.
    The American Academy of Pediatrics Committee on Nutrition (1998) Cholesterol in childhood. Pediatrics 101:141–147Google Scholar
  35. 35.
    Toussaint ND, Kerr PG (2007) Vascular calcification and arterial stiffness in chronic kidney disease: implications and management. Nephrology 12:500–509PubMedCrossRefGoogle Scholar
  36. 36.
    Vlachopoulos C, Aznaouridis K, Staefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness. A systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327PubMedCrossRefGoogle Scholar
  37. 37.
    Wang M-C, Tsai W-C, Chen J-Y, Huang J-J (2005) Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis 45:494–501PubMedCrossRefGoogle Scholar
  38. 38.
    Wang X, Keith JC, Struthers AD, Feuerstein GZ (2008) Assessment of arterial stiffness, a translational medicine biomarker system for evaluation of vascular risk. Cardiovasc Ther 26:214–223PubMedCrossRefGoogle Scholar
  39. 39.
    Weber KT, Brilla CG (1991) Pathological hypertrophy and cardiac interstitium. Circulation 83:1849–1865PubMedCrossRefGoogle Scholar
  40. 40.
    Wimmer NJ, Townsend RR, Joffe MM, Lash JP, Go AS (2007) Correlation between pulse wave velocity and other measures of arterial stiffness in chronic kidney disease. Clin Nephrol 68:133–143PubMedGoogle Scholar
  41. 41.
    Zieske AW, Malcom GT, Strong JP (2002) Natural history and risk factors of atherosclerosis in children and youth: the PDAY study. Pediatr Pathol Mol Med 21:213–237PubMedCrossRefGoogle Scholar
  42. 42.
    Zoungas S, Asmar RP (2007) Arterial stiffness and cardiovascular outcome. Clin Exp Pharmacol Physiol 34:647–651PubMedCrossRefGoogle Scholar

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

Personalised recommendations