Capillary rarefaction: an early marker of microvascular disease in young hemodialysis patients (original) (raw)
Related papers
Mineral Metabolism and Vascular Damage in Children on Dialysis
Journal of the American Society of Nephrology, 2007
Cardiovascular disease is increasingly recognized as a life-limiting problem in young patients with chronic kidney disease, but there are few studies in children that describe its determinants. We studied the association of intact parathyroid hormone (iPTH) levels and their management on vascular structure and function in 85 children, ages 5-18 years, who had received dialysis for Ն6 months. Compared to controls, dialysis patients had increased carotid intima-media thickness and pulse-wave velocity. All vascular measures positively correlated with serum phosphorus levels, while carotid intima-media thickness and cardiac calcification score also correlated with iPTH levels. Patients with mean time-integrated iPTH levels less than twice the upper limit of normal (n ϭ 41) had vascular measures that were comparable to age-matched controls, but those with iPTH levels greater than twice the upper limit of normal (n ϭ 44) had greater carotid intima-media thickness, stiffer vessels, and increased cardiac calcification than controls. Patients with increased carotid intima-media thickness had stiffer vessels and a greater prevalence of cardiac calcification. There was a strong dose-dependent correlation between vitamin D and all vascular measures, and calcium intake from phosphate binders weakly correlated with carotid intima-media thickness. In conclusion, both iPTH level and dosage of vitamin D are associated with vascular damage and calcification in children on dialysis.
Nephrology Dialysis Transplantation, 2011
Background. In patients with chronic kidney disease (CKD), disorders of mineral metabolism are associated with vascular calcifications and mortality. Microvascular dysfunction, by affecting flow resistance and tissue perfusion, may explain the cardiovascular sequelae of CKDassociated disorders of mineral metabolism. We investigated whether advanced CKD is associated with a decrease in the functional and structural number of capillaries in skin and subsequently whether capillary rarefaction is related to mineral metabolism. Methods. Capillary density was measured by nailfold microscopy in 19 predialysis and 35 CKD Stage 5 (CKD5) patients and 19 controls. In CKD patients, calcium, phosphorus, parathyroid hormone, 25-hydroxyvitaminD3 (25vitD3) and 1,25-dihydroxyvitaminD3 (1,25vitD3) were analysed as well. Results. Capillary density at baseline was 42 6 15/mm 2 in predialysis patients, 45 6 17/mm 2 in CKD5 patients and 56 6 20/mm 2 in controls (patients versus controls, respectively, P < 0.05 and P ¼ 0.05). Absolute capillary recruitment during post-occlusive reactive hyperaemia was 17 6 7/mm 2 , 14 6 6/mm 2 and 23 6 8/mm 2 , respectively (P < 0.05 for both patients and controls). Capillary density during venous occlusion was 59 6 20/mm 2 , 59 6 21/mm 2 and 77 6 21/mm 2 , respectively (P < 0.05 for both patients and controls). In multiple regression analysis, both serum phosphorus and bicarbonate values were independently and inversely associated with capillary density at baseline (r 2 of model ¼ 19%) as well as during venous occlusion (r 2 of model ¼ 28%). Furthermore, both serum phosphorus and bicarbonate were inversely and female gender positively correlated with capillary density during recruitment (r 2 of model ¼ 37%). Conclusion. Advanced CKD is characterized by an impaired functional and structural capillary density in skin, which is related to both high phosphorus and bicarbonate values.
International Journal of Pediatrics, 2021
Objective. To evaluate the association of bone mineral biomarkers of calcium, phosphorus metabolism, and 25-hydroxy vitamin D with diastolic dysfunction of the left ventricle and left ventricle mass in predialysis chronic kidney children. Patients and Methods. A cross-sectional observational study was conducted on 60 children with chronic kidney disease and treated by conservative treatment from October 2018 to September 2019 in the Pediatric Nephrology and Cardiology Department at our University Hospital. Results. The most common causes of CKD were congenital renal anomalies accounted for 22 (36.67%) of the studied cases. The mean age of children was7.05±2.74 years, and 32 (53.33%) were males. The children who had a normal diastolic function were 32 (53.33%), while those who had diastolic dysfunction were 28 (46.67%). There was a statistically significant in serum phosphorus (pvalue = 0.03), serum PTH (pvalue = 0.002), and hypertension (pvalue = 0.03). There was a statistically sig...
Traditional and “new” cardiovascular risk markers and factors in pediatric dialysis patients
Pediatric Nephrology, 2007
Cardiovascular disease (CVD) is the principal cause of mortality in patients with end-stage renal disease (ESRD). The aim of this study was to analyze carotid intima-media thickness (cIMT), endothelium-dependent dilatation (EDD), and left ventricular mass index (LVMI) as the cardiovascular risk markers and to investigate the independent risk factors of these markers in pediatric dialysis patients. This study included 39 children and adolescents undergoing dialysis (15 hemodialysis and 24 peritoneal dialysis) and 15 age-and gender-matched healthy subjects. The cIMT and EDD were assessed by high-resolution ultrasound, and LVMI was calculated from standard echocardiographic measurements. Compared with control subjects, cIMT standard deviation scores (SDS), LVMI, total homocysteine (tHcy), and high-sensitivity Creactive protein (hs-CRP) values were significantly higher in patients, but EDD values did not differ. The mean hs-CRP level was significantly higher in hemodialysis (HD) patients than in peritoneal dialysis (PD) patients. The cIMT-SDS and LVMI were associated with several variables in univariate analysis. Stepwise linear regression analysis, indexed SBP (p=0.017), and hemoglobin (p=0.001) turned out to be independent variables for predicting LVMI, and a significant predictor of cIMT was indexed diastolic blood pressure (DBP) (p=0.035). The causes of atherosclerosis and left ventricular hypertrophy are multifactorial in children and adolescents with ESRD. Better management of hypertension and anemia may be priorities for preventing or improving CVD in these patients.
GEGET, 2011
Background: Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and prevent hypocalcemic tetany. It has other roles including modulation of neuromuscular and immune function and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D. Decreased serum levels of vitamin D have been related to arterial stiffening and vascular calcifications in haemodialysis (HD) patients but the pathophysiology of this association is not yet clear. Objectives: The aim of this study is to evaluate the relationship between vascular calcifications, cardiovascular risk factors especially (left ventricular mass index) and 25-hydroxyvitamin D3 [25(ОН)D 3 ] and 1,25dihydroxyvitamin D3 [1,25(ОН) 2 D 3 ] serum levels in children with chronic renal failure on regular haemodialysis. Methods: The study was conducted on 30 children regularly haemodialyzed 3 times weekly and 3 hours per t session by polysulfone membrane using citrate dialysate. All cases were subjected to detailed history taking, thorough clinical examination, laboratory investigations including assessment of serum 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 by thin layer chromatography. Echocardiography was done for evaluation of left ventricular mass index (LVMI) by Devereux's formula. Results: There was a significant and a highly significant negative correlation between left ventricular mass index (LVMI) and 25-ОН and 1-25(OH) 2 respectively. Increased left ventricular mass Index in patients without one alpha supplementation was found. Conclusion: We conclude that deficiency of [25(ОН)D 3 ] and [1,25(ОН) 2 D 3 ] is prevalent in hemodialyzed children and is associated with cardiovascular risk.
BMC Nephrology, 2015
Recent advances in our understanding of the excess mortality of chronic kidney disease (CKD) due to cardiovascular complications, obtained through observational studies, demonstrate that vascular calcification and hyperphosphatemia are major cardiovascular risk factors. Mechanistic studies demonstrate that these two risk factors are related and that hyperphosphatemia directly stimulates vascular calcification. The role of hyperphosphatemia in stimulating vascular calcification in CKD is associated with a block to the skeletal reservoir function in phosphate balance due to excess bone resorption. This has led to the realization that renal osteodystrophy is linked to vascular calcification by disordered mineral homeostasis (phosphate) and that a multiorgan system fails in CKD, leading to cardiovascular mortality. In children with renal disease, the multiorgan system fails, just as in adults, but the outcomes have been less well studied, and perceptions of differences from adults are possibly incorrect. Vascular calcification and cardiovascular mortality are less prevalent among pediatric patients, but they are present. However, CKDinduced vascular disease causes stiffness of the arterial tree causing, in turn, systolic hypertension and left ventricular hypertrophy as early manifestations of the same pathology in the adult. Because of the role of the skeleton in these outcomes, renal osteodystrophy has been renamed as the CKD mineral bone disorder (CKD-MBD). This review, which focuses on the pediatric patient population, describes our current state of knowledge with regards to the pathophysiology of the CKD-MBD, including the new discoveries related to early stages of CKD. As a new necessity, cardiovascular function issues are incorporated into the CKD-MBD, and new advances in our knowledge of this critical component of the disorder will lead to improved outcomes in CKD.
Impact of Dialysis Adequacy on Cardiac Function in Pediatric Capd Patients
2000
¨¨¨¨¨ Background: Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fun- damental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies. ¨¨¨¨¨ Objective: To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in
Reduced Microvascular Density in Omental Biopsies of Children with Chronic Kidney Disease
PLOS ONE, 2016
Background Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD.
Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay
American Journal of Life Sciences, 2014
Traditional cardiovascular risk factors are common among chronic kidney disease (CKD) patients. However the high prevalence of atherosclerosis and arterial calcification in CKD is far beyond the explanation by common cardiovascular risk factors. The aim of this study is to determine the incidence of cardiovascular calcification and its relation to demographic data, hemodialysis data and laboratory biomarkers and to evaluate the cardiovascular risk of atherosclerosis in hemodialysis patients. Fourty CKD patients on regular hemodialysis and twenty healthy volunteers were subjected to echocardiography, carotid ultrasound and laboratory studies including serum parathrmone (PTH), 25(OH) vitamin D, feutin and osteoprotegerin levels (OPG). The echocardiographic data showed a statistically significant increase in interventricular septum thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) in patients group compared to the controls. Thirty patients (75%) had valvular calcification. There was significant increase in carotid intima-media thickness (CIMT) in patients group. Serum levels of Ph, PTH and Osteoprotegerin were significantly increased, however, serum levels of Ca, Vitamin D and Feutin were significantly decreased in patients group. Serum level of Ph, and Osteoprotogerin were significantly increased while Vitamin D and feutin were significantly decreased in patients with valvular calcification compared to patients without valvular calcifications. The level of Vitamin D and Fetuin were negatively correlated with creatinine, PTH and osteoprotogerin. While, the level of osteoprotogerin and PTH were positively correlated with creatinine and with each other, they were negatively correlated with HDL-c and eGFR. CIMT was positively correlated with LVMI, PWT, urea, creatinine, CRP, Ca and was negatively correlated with EF%, eGFR, HDL-c, vitamin D and Feutin. We concluded that hemodialysis patients with valvular calcifications were older in age, with a longer hemodialysis duration and showed higher Ph level, Ca x P product and OPG level and lower 25(OH)-vitamin D and fetuin A level. Also, they showed lower EF % and were on lower doses of alphacalcidol and higher doses of calcium compared to patients without valvular calcifications. So, our study points to the importance of administration of active vitamin D derivatives to decrease the risk of valvular calcification and atherosclerosis. Serum fetuin A and osteoprotegerin can be used as a simple, easily performed biomarkers mirroring valvular calcification in hemodialysis patients. Further studies should be done to assess trials for the addition of fetuin A in the treatment of CKD patients to prevent the occurrence of calcification.
Cardiac and Vascular Adaptation in Pediatric Patients with Chronic Kidney Disease
Journal of the American Society of Nephrology, 2005
In children, cardiac abnormalities such as increased left ventricular mass (LVM) and diastolic dysfunction develop at the time of mild to moderate chronic renal insufficiency (CRI) and progress as renal function deteriorates. It was hypothesized that in this age group, vascular abnormalities develop early in the course of chronic kidney disease (CKD) in parallel with cardiac abnormalities and become more severe as end-stage disease is reached. Echocardiography and ultrasound of the carotid artery were performed on 44 patients with CKD stages 2 to 4 (CRI group), 16 patients who were on maintenance dialysis, and 35 healthy individuals. Carotid artery intima-media thickness (cIMT) was measured and distensibility and stiffness were calculated to assess carotid artery structure and function. Both the CRI and dialysis groups had greater cIMT, higher LVM index, and poorer diastolic function than the control subjects (P < 0.0001). Children who were on dialysis had greater cIMT and higher LVM index than those with CRI (P < 0.001) and greater arterial stiffness than both CRI patients and control subjects (P < 0.001). Arterial compliance was similar in CRI and control subjects. In all patients with CKD (CRI and dialysis), increased calcium-phosphorus product predicted increased cIMT. Increased serum phosphorus and intact parathyroid hormone predicted increased arterial stiffness. Elevated intact parathyroid hormone was a predictor of increased LVM index and poor diastolic function. In dialysis patients, the cumulative dose of phosphate binders and calcitriol predicted abnormal vascular structure and function. It is concluded that vascular abnormalities are already present in children and adolescents during early stages of CKD; they are more severe in children who are on maintenance dialysis and are related to abnormal calcium-phosphorus metabolism.