Published online before print June 21, 2004, doi: 10.1161/01.CIR.0000133412.53089.26
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(Circulation. 2004;110:97-101.)
© 2004 American Heart Association, Inc.
Original Articles |
Abnormal Carotid Artery Structure and Function in Children and Adolescents With Successful Renal Transplantation
From the Division of Nephrology and Hypertension (M.M.M.) and Division of Cardiology (T.R.K., S.A.W., B.J.G., P.R.K., S.R.D.), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.
Correspondence to Mark Mitsnefes, MD, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital, MLC 7022, 3333 Burnet Ave, Cincinnati, OH 45229–3039. E-mail mark.mitsnefes{at}cchmc.org
Received December 2, 2003; de novo received January 22, 2004; revision received March 16, 2004; accepted March 17, 2004.
Background— Abnormal carotid artery compliance and increased intima-media thickness (IMT), markers of early atherosclerosis, are prevalent in adults with chronic kidney failure. However, little is known about the extent of these abnormalities in children after transplantation.
Methods and Results— Thirty-one children (age, 14.5±4.1 years) with renal transplant (estimated glomerular filtration rate, 78.1±24.5 mL/min per 1.73 m2; range, 44 to 128 mL/min per 1.73 m2) and 33 age- and sex-matched control subjects had ultrasound of the carotid artery, echocardiography, and ambulatory blood pressure monitoring (transplant patients only). IMT was measured, and distensibility and stiffness parameter (ß) were calculated to assess carotid artery structure and function. The results were correlated with demographic, clinical, and biochemical variables. Compared with control subjects, children with transplant had higher IMT (P=0.03) and ß (P<0.0001) and lower distensibility (P<0.001). In multiple regression analysis, increased IMT in children who had received transplants was associated with higher mean office systolic blood pressure taken within 1 year before the study (R2=0.19, P=0.024) and receipt of >1 transplant (R2=0.16, P=0.02). Worse distensibility and ß were significantly associated with higher daytime systolic blood pressure load calculated from ambulatory blood pressure and receipt of cadaveric kidney. When number of antihypertensives was added to the models, only higher number of blood pressure medications independently predicted abnormal distensibility (R2=0.38, P=0.002) and ß (R2=0.25, P=0.016).
Conclusions— Carotid arteriopathy is present in children with successful renal transplant and is associated with hypertension. The results suggest that these children might be at risk for accelerated atherosclerosis and premature cardiovascular disease.
Key Words: carotid arteries • cardiovascular diseases • kidney • pediatrics • transplantation
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