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Reducing the burden of cardiovascular disease in children with chronic kidney disease: prevention vs. damage limitation

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Abstract

Cardiovascular disease (CVD) is a life-limiting condition in patients with chronic kidney disease (CKD) and is rapidly progressive, especially in those with stage 5 CKD and on dialysis. Cardiovascular mortality, although reducing, remains at least 30 times higher than in the general pediatric population. The American Heart Association guidelines for cardiovascular risk reduction in high-risk pediatric patients has stratified pediatric CKD patients in the “high risk” category for the development of CVD, with associated pathological and/or clinical evidence for manifest coronary disease before 30 years of age. While improving patient survival is a key priority, other patient-related outcomes, such as psychosocial development, quality of life and growth are of major importance to children and their caregivers. Once vascular damage or calcification has developed, there are no data to suggest that they can be reversed. Treatments such as intensified dialysis and transplantation may attenuate the progression of subclinical cardiovascular disease, but no treatment to date has shown that the inexorable progression of CVD in CKD can be reversed. Thus, our management must focus on early diagnosis and robust preventative strategies to give our patients the best chance of optimal cardiovascular health and survival. In this review, the pathophysiology and importance of preventing the development of CVD in CKD is discussed.

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Funding

RS is funded by a National Institute for Health Research (NIHR), Career Development Fellowship for this research project. This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

A part of the work took place in the Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.

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  1. UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, WC1N 3JH, UK

    Rukshana Shroff

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Correspondence to Rukshana Shroff.

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Shroff, R. Reducing the burden of cardiovascular disease in children with chronic kidney disease: prevention vs. damage limitation. Pediatr Nephrol 36, 2537–2544 (2021). https://doi.org/10.1007/s00467-021-05102-y

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