Abstract
The aim of the study was to evaluate changes in the arterial wall in children with chronic kidney disease (CKD). We studied 60 patients: 32 with stages 2–4 CKD [chronic renal failure (CRF)], 28 with stage 5 CKD [end-stage renal disease (ESRD)], and 43 controls (C). The evaluated parameters included intima–media thickness (IMT) of the carotid arteries, bone mineral density (BMD), serum lipid levels, and parameters of the calcium–phosphorus metabolism. Patients were divided into two groups: group 1 with normal arteries, and group 2 with arterial changes. The highest serum fetuin A level was found in group 1 compared with groups 2 and C. A negative correlation between IMT and fetuin A level was found. In patients with ESRD, a positive correlation of IMT with phosphorus level and age and a negative correlation with cyclase-activating parathyroid hormone and cyclase inhibiting parathyroid hormone (CAP/CIP) ratio was observed. Multiple linear regression showed that lower fetuin-A and alkaline phosphatase (AP) levels and higher lumbar spine BMD independently predicted higher IMT. Arterial wall changes in children with CKD were related to lower fetuin A and AP level and higher BMD. Low CAP/CIP and high phosphorus level may also be significant factors for arterial changes in patients with ESRD.
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Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM (1998) Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension 32:570–574
Nayir A, Bilge I, Kilicaslan I, Ander H, Emre S, Sirin A (2001) Arterial changes in paediatric haemodialysis patients undergoing renal transplantation. Nephrol Dial Transplant 16:2041–2047
Goodman WG, Goldin J, Kuizon BD, Yoon Ch, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483
McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662
Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629
Benedetto FA, Mallamaci F, Tripepi G, Zoccali C (2001) Prognostic value of ultrasonographic measirement of carotid intima media thickness in dialysis patients. J Am Soc Nephrol 12:2458–2464
Litwin M, Wühl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500
O’Leary DH, Polak JF, Kronmal RA, Mamolio TA, Burke GL, Wolfson SK Jr (1999) Carotid artery intima-media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 34:14–22
Nishizawa Y, Shoji T, Wagasue K, Okuno S, Kim M, Emoto M, Ishimura E, Nakatani T, Miki T, Inaba M (2003) Intima-media thickness of carotid artery predicts cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 41 (3 Suppl 1):S76–S79
National Cholesterol Education Program (NCPEM) (1992) Highlights of the report of the expert panel on blood cholesterol level in children and adolescents. Pediatrics 89:495–501
Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC (1996) Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 27:394–401
Guerin AP, London GM, Marchais SJ, Metivier F (2000) Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 15:1014–1021
Tamashiro M, Iseki K, Sunagawa O, Inoue T, Higa S, Afuso H, Fukiyama K (2001) Significant association between progression of coronary artery calcification and dyslipidemia in patients on chronic hemodialysis. Am J Kidney Dis 38:64–69
Chertow GM, Burke SK, Raggi P (2002) Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 62:245–252
Braun J, Asmus HG, Holzer H, Brunkhorst R, Krause R, Schulz W, Neumayer HH, Raggi P, Bommer J (2004) Long-term comparison of calcium-free phosphate binder and calcium carbonate-phosphorus metabolism and cardiovascular calcification. Clin Nephrol 62:104–115
Wilson PW, Kannel WB, Silbershatz H, D’Agostino RB (1999) Clustering metabolic factors and coronary heart disease. Arch Intern Med 159:1104–1109
Jono S, McKee MD, Murry ChE, Shioi A, Nishizawa Y, Mori K, Morii H, Giachelli CM (2000) Phosphate regulation of vascular smooth muscle cell calcification. Circ Res 87:10–17
Reynolds JL, Joannides AJ, Skepper JN, McNair R, Schurgers L, Proudfoot D, Jahnen-Dechent W, Weissberg PL, Shanahan CM (2004) Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. J Am Soc Nephrol 15:2857–2867
Kurz P, Monier-Faugere M-C, Bognar B, Werner E, Roth P, Vlachojannis J, Malluche HH (1994) Evidence for abnormal calcium homeostasis in patients with adynamic bone disease. Kidney Int 46:855–861
Stompór T, Pasowicz M, Sułowicz W, Dembinska-Kiec A, Janda K, Wojcik K, Tracz W, Zdzienicka A, Klimeczek P, Janusz-Grzybowska E (2003) An association between coronary artery calcification score, lipid profile, and selected markers of chronic inflammation in ESRD patients treated with peritoneal dialysis. Am J Kidney Dis 41:203–211
Poyrazoğlu HM, Dűşűnsel R, Yikilmaz A, Narin N, Anarat R, Gűndűz Z, Coşkun A, Baykan A, Őztűrk A (2007) Carotid artery thickness in children and young adults with end-stage renal disease. Pediatr Nephrol 22:109–116
Bucay N, Sarosi I, Dunstan CR, Marony S, Tarpley J, Capparelli C, Scully S, Tan HL, Xu W, Lacey DL, Boyle WJ, Simonet WS (1998) Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification. Genes Dev 12:1260–1268
Jono S, Ikari Y, Shioi A, Mori K, Miki T, Hara K, Nishizawa Y (2002) Serum osteoprotegerin levels are associated with the presence and severity of coronary artery disease. Circulation 106:1192–1194
Nitta K, Akiba T, Uchida K, Otsubo S, Takei T, Yumura W, Kabaya T, Nihei H (2004) Serum osteoprotegerin levels and the extent of vascular calcification in haemodialysis patients. Nephrol Dial Transplant 19:1886–1889
Moe S, Reslerova M, Ketteler M, O’Neil K, Duan D, Koczman J, Westenfeld R, Jahnen-Dechent W, Chen NX (2005) Role of calcification inhibitors in the pathogenesis of vascular calcification in chronic kidney disease (CKD). Kidney Int 67:2295–2304
Coen G, Ballanti P, Balducci A, Calabria S, Fischer MS, Jankovic L, Manni M, Morosetti M, Moscaritolo E, Sarde D, Bonucci E (2002) Serum osteoprotegerin and renal osteodystrophy. Nephrol Dial Transplant 17:233–238
Kazama JJ, Omori K, Yamamoto S, Ito Y, Maruyama H, Narita I, Gejyo F, Iwasaki Y, Fukagawa M (2006) Circulating osteoprotegerin affects bone metabolism in dialysis patients with mild secondary hyperparathyroidism. Ther Apher Dial 10:262–266
Schäfer C, Heiss A, Schwarz A, Westenfeld R, Ketteler M, Floege J, Muller-Esterl W, Schinke T, Jahnen-Dechent W (2003) The serum protein alpha2-Heremans-Schmid glycoprotein/fetuin A is a systemically acting inhibitor of ectopic calcification. J Clin Invest 112:357–366
Ketteler M, Bongartz P, Westenfeld R, Wildberger JE, Mahnken AH, Böhm R, Metzger T, Wanner C, Jahnen-Dechent W, Floege J (2003) Association of low fetuin A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross sectional study. Lancet 361:827–833
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Ziolkowska, H., Brzewski, M. & Roszkowska-Blaim, M. Determinants of the intima–media thickness in children and adolescents with chronic kidney disease. Pediatr Nephrol 23, 805–811 (2008). https://doi.org/10.1007/s00467-007-0733-6
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DOI: https://doi.org/10.1007/s00467-007-0733-6