Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease

Lopes, Renata; Morais, Mauro Batista de; Oliveira, Fernanda Luisa Ceragioli; Brecheret, Ana Paula; Abreu, Ana Lucia Cardoso Santos; Andrade, Maria Cristina de

doi:10.1016/j.jped.2018.06.010

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Original articles • J. Pediatr. (Rio J.) 95 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.jped.2018.06.010 copy

Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease.

Material and methods:

Observational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25-I75: 9.2-14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016.

Results:

Of the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR = 1.30, p = 0.037) and stages I and II arterial hypertension (PR = 1.42, p = 0.011) were independently associated with carotid intima-media thickness alterations.

Conclusion:

The prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.

Keywords
Chronic kidney disease; Cardiovascular diseases; Carotid intima-media thickness; Adolescents; Children

	Altered carotid/height (n = 41)
	Total	N	%	PR	95% CI	p
Demographic characteristics
Gender						0.803
Female	22	16	72.7	1.00
Male	33	25	75.8	1.04	0.76-1.43
Age (years)						0.615
Median (I25; I75)	11.9 (9.2; 14.8)	11.1 (9.2; 14.7)	0.99	0.94-1.03
Age range						0.400
<12 years	29	23	79.3	1.00
≥12 years	26	18	69.2	0.87	0.64-1.20
Pubertal stage						0.063
Prepubertal	32	21	65.6	1.00
Pubertal	23	20	87.0	1.32	0.98-1.78
Clinical characteristics
Etiology of CKD
Urinary tract malformation	30	25	83.3	1.00
Glomerulopathy	7	6	85.7	1.03	0.73-1.45	0.872
Others	18	10	55.6	0.67	0.43-1.04	0.073
Time of CKD (years)						0.520
Median (I25; I75)	5.5 (2.1; 9.0)	5.0 (2.0; 9.0)	0.99	0.95-1.03
Duration of CKD						>0.999
<1 year	5	4	80.0	1.00
1-2 years	6	5	83.3	1.04	0.59-1.83	0.888
2-5 years	15	11	73.3	0.92	0.54-1.56	0.749
≥5 years	29	21	72.4	0.90	0.55-1.48	0.692
Treatment						0.738
Conservative	43	32	74.4	1.00
Peritoneal dialysis	5	3	60.0	0.81	0.38-1.68
Hemodialysis	7	6	85.7	1.15	0.81-1.63
CKD stage						0.341
Stage 2	10	5	50.0	1.00
Stage 3A	7	5	71.4	1.43	0.66-3.11
Stage 3B	12	9	75.0	1.50	0.74-3.02
Stage 4	10	9	90.0	1.80	0.94-3.46
Stage 5	16	13	81.2	1.62	0.84-3.15
Clinical characteristics
Blood pressure classification ^a a Flynn et al., 2017.8						0.124
Normal	28	18	64.3	1.00
Elevated	5	3	60.0	0.93	0.43; 2.01	0.860
Stage I arterial hypertension	17	15	88.2	1.37	0.99; 1.90	0.057
Stage II arterial hypertension	5	5	100.0	-
Blood pressure classification^a a Flynn et al., 2017.8						0.016
Normal or elevated	33	21	63.6	1.00
Stage I or II hypertension	22	20	90.9	1.43	1.07; 1.91
Anthropometric indexes
BMI^b b Body mass index (BMI). /Age z
Median (I25; I75)	-0.6 (-1.5; +0.5)	-1.0 (-1.5; -0.1)
Nutritional status ^c c WHO, 2006.9						0.003
Thinness	7	5	71.4	0.82	0.51; 1.34	0.440
Normal weight	37	32	86.5	1.00
Excess weight	11	4	36.4	0.42	0.93; 1.19	0.032
Height/age z						0.290
Median (I25; I75)	-1.0 (-2.6; -0.0)	-1.2 (-2.6; -0.2)	0.96	0.89-1.03
Adequate	35	26	74.3	1.00
Short stature (<-2)	20	15	75.0	1.01	0.73-1.39
Adiposity
Abdominal circumference (cm) ^d d Freedman et al., 1999.10
Median (I25; I75)	60.2 (56.0; 69.2)	59.0 (56.0; 67.0)	-
Adequate (<P90)	53	41	77.4	-
Elevated (≥P90)	2	0	0.0	-
Body fat (%)						0.044
Median (I25; I75)	18.9 (17.4; 24.1)	18.3 (17.3; 20.2)	0.97	0.94-1.00
Body fat ^e e McCarthy et al., 2006.12
Low deposit of fat	1	1	100.0	-
Adequate	42	35	83.3	1.00
Excess	4	2	50.0	0.60	0.22; 1.61	0.312
Obesity	8	3	37.5	0.45	0.18; 1.11	0.084
Laboratory tests
Uric acid (mg/dL)						0.178
Median (I25; I75)	5.5 (5.0; 6.6)	5.2 (4.9; 6.3)	0.91	0.80; 1.04
Uric acid						0.122
≤5.7	30	25	83.3	1.00
>5.7	25	16	64.0	0.77	0.55; 1.07
CRP (mg/L)						<0.001
Median (I25; I75)	1.1 (0.6; 2.2)	1.0 (0.6; 2.7)	1.01	1.00; 1.01
CRP						0.392
≤1	25	20	80.0	1.00
>1	30	21	70.0	0.87	0.64; 1.19
Total cholesterol (mg/dL)
Median (I25; I75)	175.0 (150.0; 201.0)	177.0 (151.0; 208.0)	-
Total cholesterol ^f f Giuliano et al., 2005.14						0.442
Desirable	12	9	75.0	1.00
Borderline	13	8	61.5	0.82	0.48; 1.41	0.473
Increased	30	24	80.0	1.07	0.73; 1.55	0.734
LDL (mg/dL) ^f f Giuliano et al., 2005.14
Median (I25; I75)	102.0 (85.0; 126.0)	108.5 (86.5; 131.5)	-
LDL (mg/dL) ^a a Flynn et al., 2017.8						0.394
Desirable	26	18	69.2	1.00
Borderline	17	12	70.6	1.02	0.68; 1.52	0.924
Increased	11	10	90.9	1.31	0.96; 1.80	0.092
HDL (mg/dL)						0.698
Median (I25; I75)	47.0 (39.0; 54.0)	47.0 (39.0; 54.0)	1.00	0.98; 1.01
HDL (mg/dL) ^f f Giuliano et al., 2005.14						0.826
≥45 mg/dL	34	25	73.5	1.00
<45 mg/dL	21	16	76.2	1.04	0.76; 1.42
Triglycerides (mg/dL)
Median (I25; I75)	108.0 (73.0; 142.0)	108.0 (76.0; 138.0)	-
Triglycerides ^f f Giuliano et al., 2005.14						0.234
Desirable	23	17	73.9	1.00
Borderline	13	12	92.3	1.25	0.93; 1.67	0.132
Increased	19	12	63.2	0.85	0.56; 1.30	0.464

	Univariate
	bPR (95% CI)	p
Pubertal stage - Pubertal × Prepubertal	1.32 (0.98; 1.78)	0.063
CKD etiology
Glomerulopathy × Malformation	1.03 (0.73; 1.45)	0.872
Others × Malformation	0.67 (0.43; 1.04)	0.073
CKD stage
Stage 3A or 3B × Stage 2	1.47 (0.75; 2.89)	0.261
Stage 4 × Stage 2	1.80 (0.94; 3.46)	0.078
Stage 5 × Stage 2	1.62 (0.84; 3.15)	0.151
%Body Fat	0.97 (0.94; 1.00)	0.044
Blood pressure Stage I or II Hypertension × Normal or Elevated	1.43 (1.07; 1.91)	0.016
CRP	1.01 (1.00; 1.01)	<0.001
LDL
Borderline × Desirable	1.02 (0.68; 1.52)	0.924
Increased × Desirable	1.31 (0.96; 1.80)	0.092

	Multivariate
	adjPR (95% CI)	p
Pubertal stage - Pubertal × Prepubertal	1.30 (1.01; 0.66)	0.037
Blood pressure Stage I or II Hypertension × Normal or Elevated	1.42 (1.08; 1.85)	0.011

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[1] * Corresponding author. E-mail:renutri@uol.com.br (R. Lopes).