Kidney Week

Abstract: SA-OR85

Assessing Baseline Cardiovascular Disease for Kids Initiating Kidney Replacement Therapy: ABCD4Kids Study

Session Information

• Pediatric Nephrology: Clinical and Genetic Studies
  November 04, 2023 | Location: Room 105, Pennsylvania Convention Center
  Abstract Time: 05:33 PM - 05:42 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Khandelwal, Priyanka, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom

Priyanka Khandelwal, MD

• Hofstetter, Jonas, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

Jonas Hofstetter,

• Schmitt, Claus Peter, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

Claus Peter Schmitt,

• Melk, Anette, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany

Anette Melk,

• Querfeld, Uwe, Charité Children's Hospital, Berlin, Germany

Uwe Querfeld,

• Schaefer, Franz S., Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

Franz S. Schaefer,

• Shroff, Rukshana, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom

Rukshana Shroff,

Group or Team Name

• 4C Study Consortium.

Background

Information on cardiovascular (CV) damage in children initiating kidney replacement therapy (KRT) is limited. We evaluated the CVD burden in incident dialysis and preemptive transplant recipients from two multicenter cohorts: Cardiovascular Comorbidity in Childhood CKD (4C) and Haemodiafiltration, Heart and Height (3H) studies.

Methods

The incident KRT cohort was compared with independent cross-sectional cohorts: CKD stage 3b (median eGFR 34 ml/min/1.73m²), 1-year on dialysis, and 1-year after transplantation. Structural (carotid intima-media thickness, cIMT-SDS, left ventricular mass index, LVMI) and functional (pulse wave velocity, PWV-SDS; and distensibility SDS) CVD indices were measured in all.

Results

248 incident KRT patients, median age 14 yr, eGFR 12.2 ml/min/1.73m², 63% boys were studied. 82 (33%) were pre-emptively transplanted. At KRT initiation, pre-emptively transplanted patients had higher eGFR and lower 24-hr mean arterial BP, PWV-SDS and PTH compared to patients starting dialysis (P<0.01 for all). Incident KRT patients had significantly higher CV burden than the CKD3b cohort: elevated cIMT-SDS and PWV-SDS in 40% and 21% respectively and LV hypertrophy in 41% (Fig). Incident KRT patients had uncontrolled ambulatory (23%) and masked (21%) hypertension; whereas systolic BP and 24-hr mean arterial BP were lower following KRT initiation. While PWV-SDS was lower in transplanted patients, there was no difference in cIMT-SDS or LVMI (Fig). In incident KRT patients the independent predictors of PWV-SDS were systolic BP SDS (ß=0.36, P<0.001) and higher PTH (ß=0.27; P=<0.001). LVMI independently associated with systolic BP SDS (ß=0.30, P<0.001), higher BMI SDS (ß=0.20; P=0.001), lower hemoglobin (ß=0.17; P=0.008) and lower calcium (ß=0.15; P=0.01).

Conclusion

Incident KRT patients have a high burden of sub-clinical CVD comparable to that seen in chronic dialysis patients. Early intervention to manage modifiable risk factors is essential.

Funding

• Government Support – Non-U.S.