Abstract 19661: Ultra High Frequency Ultrasound in Detection of Intimal and Medial Changes in Pediatric Kidney Disease
Introduction: Premature arterial disease has been reported in chronic kidney disease (CKD) patients. However, using conventional methods it is not possible to determine whether these are driven by metabolic (medial) abnormalities rather than traditional cardiovascular (intimal) risk factors.
Hypothesis: Using an ultra high-resolution ultrasound (UHRUS) technique to measure medial and intimal arterial changes will allow assessment of their determinants and progression in predialysis, dialysis and renal transplanted children.
Methods: Intimal (IT) and medial (MT) thickness of the carotid, radial and dorsal pedal arteries were measured by UHRUS (40-750MHz) in 54 children (19 pre-dialysis CKD, 20 on dialysis and 15 post-transplant) at baseline and compared to 20 matched healthy controls. One year follow up measurements were performed in 24 children (11 pre-dialysis CKD and 15 post-transplant). Conventional ultrasound (CUS) for carotid IMT was measured for comparison.
Results: All CKD patients had higher radial IT compared to controls (p=0.05). CUS measurements were similar between patient groups.
CKD children on dialysis for >1year had greater carotid and dorsal pedal MT compared to those on dialysis for < 1year (p = 0.007). In the CKD and dialysis children (n=39), higher carotid MT at baseline was associated with increased serum phosphate (p<0.001, r=0.42) and PTH levels (p=0.03, r=0.27). In transplanted patients, higher carotid radial IT was associated with higher total cholesterol (p=0.02, r=0.31).
At 1-year follow-up transplanted children had a decrease in carotid and radial MT (p = 0.01 for both), but an increase in dorsal pedal IT (p=0.04). Increased dorsal pedal IT in transplanted patients was associated with a higher systolic BP z- score (p = 0.2, r = 0.22). Children with pre-dialysis CKD (n=6) had a decrease in radial MT (p=0.04), but no other significant changes.
Conclusions: UHRUS assessment in CKD patients identified modifiable risk factors for intimal and medial vascular disease, which were not detected by CUS. Our findings suggest vascular remodeling in response to a changing cardiovascular risk factor profile after renal transplantation and provide important information for effective CV stratification and treatment of these patients.
Author Disclosures: F. Dangardt: None. M. Charakida: None. D. Bhowruth: None. D. Thurn: None. A. Rapala: None. F. Schaefer: None. J. Deanfield: None. R. Shroff: None.
- © 2016 by American Heart Association, Inc.