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Dilatation of the aorta in children with advanced chronic kidney disease

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Abstract

Background

The peculiarity of the cardiovascular risk profile with increased arterial vulnerability is well known in adults with chronic kidney disease (CKD). It is explained by an increased incidence of traditional cardiovascular risk factors together with other comorbidities related to the uremic condition and cardiorenal syndrome (CRS). The present study aimed to determine the cardiovascular impact of the uremic condition in a pediatric population with advanced CKD.

Methods

From 2016 to 2018, 39 consecutive patients with advanced CKD who underwent echocardiographic evaluation were included. All echocardiographic examinations were performed by the same operator (FE). Demographic, clinical, biological, and echocardiographic data were collected.

Results

The mean age at echocardiographic exam was 9.7 ± 4.6 years. Twenty-four (61.5%) patients were on hemodialysis; 17 (43.6%) patients were in a peritoneal dialysis program of whom 11 switched at a later stage to hemodialysis. Eight (20.5%) patients had an arteriovenous fistula (AVF). Hypertension was present in 30 (76.9%) patients while left ventricular hypertrophy (LVH) was described in 13 (33.3%) patients. Dilatation of the ascending aorta (Z-score > 2) was found in 15 (38.4%) patients and was statistically (in univariate analysis) related to gender, hypertension, the presence of an AVF, and the use of hemodialysis after peritoneal dialysis (p = 0.024, p = 0.016, p = 0.006, p = 0.009, respectively).

Conclusion

In addition to classical and predictable abnormalities related to CKD, we found a high prevalence of dilatation of the ascending aorta in children with advanced CKD. Hypertension, AVF, and hemodialysis were associated factors.

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Abbreviations

AD:

Aortic dilatation

A4C:

Apical 4 chamber

AVF:

Arteriovenous fistula

CRS:

Cardiorenal syndrome

CD:

Cardiovascular disease

CKD:

Chronic kidney disease

CKD-5:

Chronic kidney disease stage 5

KRT:

Kidney replacement therapy

KT:

Kidney transplant

LV:

Left ventricle

LVH:

Left ventricular hypertrophy

LVMI:

Left ventricular mass index

PWD:

Power wave Doppler

TDI:

Tissue Doppler imaging

TTE:

Transthoracic echocardiography

2D:

Two dimensional

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Author notes

  1. Sophie Quennelle and Fedoua El Louali contributed equally to this work.

Authors and Affiliations

  1. Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France

    Sophie Quennelle, Caroline Ovaert✉ & Fedoua El Louali

  2. Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France

    Mathilde Cailliez, Florentine Garaix & Michel Tsimaratos

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  1. Sophie Quennelle
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  2. Caroline Ovaert✉
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Correspondence to Fedoua El Louali.

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Quennelle, S., Ovaert✉, C., Cailliez, M. et al. Dilatation of the aorta in children with advanced chronic kidney disease. Pediatr Nephrol 36, 1825–1831 (2021). https://doi.org/10.1007/s00467-020-04887-8

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