Nefrología (English Edition) (Jul 2021)
Endothelial dysfunction in children with chronic kidney disease
Abstract
Background and Objective: Cardiovascular disease (CVD) is the main cause of death in children with chronic kidney disease (CKD). Inflammation and endothelial dysfunction (ED) are found in the majority of these patients and are factors associated to CVD. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating ED. Our objective was to identify risk factors associated to ED in children with CKD. Materials and Methods: Children 2–16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1b, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if <7%. Results: Included were 129 patients aged 13.1 ± 2.6 years. FMD < 7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 mg/dl vs. 120.0 mg/dl, P = .042, y 1.24 U/L vs. 0.55 U/L, P = .007, respectively), as well as higher frequency of low iPTH (19.1% vs. 4.9%, P = .036). Levels of hsCRP correlated significantly with FMD (Rho = −0.28, P = .003). Patients with low iPTH (OR = 4.41, 95%CI 1.13–17.27, P = .033) and increased hsCRP (OR = 2.89, 95%CI 1.16–7.17, P = .022) had higher adjusted risk of having FMD < 7%. Conclusions: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for CVD. Resumen: Antecedentes y Objetivo: La enfermedad cardiovascular (ECV) es la principal causa de muerte en niños con Enfermedad Renal Crónica (ERC). La inflamación y la disfunción endotelial (DE) se presenta en la mayoría de estos pacientes y son factores asociados a ECV. La dilatación mediada por flujo (DMF) <7% es un marcador subrogado validado en la evaluación de la DE. Nuestro objetivo fue identificar los factores de riesgo asociados a DE en niños con ERC. Materiales y Métodos: Se estudió a niños de 2–16 años de edad. Se recopiló su información clínica y variables bioquímicas, incluidos Hormona Paratiroidea Intacta (iPTH), interleucinas 6 y 1b, Proteína C Reactiva de alta sensibilidad (hsCRP), Glutatión reducido, óxido nítrico, malondialdehído, y homocisteína. Se consideró DMF alterada <7%. Resultados: Se incluyó a 129 pacientes con edad de 13.1 ± 2.6 años. Tuvieron DMF < 7% 69 (52.7%). Los pacientes con DMF < 7% tuvieron niveles más altos de triglicéridos y de hsCRP que aquellos con DMF ≥ 7% (145.5 mg/dl vs. 120.0 mg/dl, P = .042, y 1.24 U/L vs. 0.55 U/L, P = .007, respectivamente), así como una mayor frecuencia de iPTH baja (19.1% vs. 4.9%, P = .036). Los niveles de hsCRP se correlacionaron significativamente con la DMF (Rho = −0.28, P = .003). Los pacientes con iPTH baja (OR = 4.41, 95% CI 1.13–17.27, P = .033) y con hsCRP incrementada (OR = 2.89, 95%CI 1.16–7.17, P = .022) tuvieron un riesgo ajustado mayor de DMF < 7%. Conclusiones: La hipertrigliceridemia, la inflamación e iPTH baja se asociaron significativamente a una DMF alterada. Son factores de riesgo de ECV frecuentes y tratables.
