Cardiovascular Consequences in Children with Chronic Kidney Disease: A Hospital Based Cross-Sectional Study
- 1. Junior Resident, Department of Emergency Medicine, Aarupadai Veedu Medical College & Hospital, Puducherry, India
- 2. Consultant Paediatrician, Neolife Children's Hospital, Chennai, Tamil Nadu
- 3. Specialist Internist, Kanad Hospital, Al Ain, Abu Dhabi, United Arab Emirates
Description
Objectives: To determine the proportion of children with chronic kidney disease requiring dialysis; and to determine the factors associated with children with CKD requiring or not requiring dialysis. Methods: This was a hospital based cross-sectional study with prospective enrolment of patients (children 1 to 18 years of age with chronic kidney disease (CKD, glomerular filtration rates less than 60 ml/min/1.73 m2)) conducted in the Department of Paediatrics, in a tertiary healthcare facility in central India between June 2020 and December 2021. Results: The majority of participants were males (81.3%), and three-quarters were aged ten or older. CKD stages varied, with 38.7% at stage 3, 40.0% at stage 4, and 21.3% at stage 5 and/or requiring dialysis. Several nutritional and hematologic abnormalities were observed, with 72.0% of children being underweight, 52.0% having anemia, and 42.7% presenting with proteinuria. Additionally, 46.7% exhibited abnormal calcium-phosphorus (Ca x PO4) product. The study reported a high prevalence of hypertension, with 22.7% having clinical hypertension and 90.7% having ambulatory hypertension. Metabolic disturbances were notable, including hyperkalaemia (17.3%) and acidosis (60.0%). Among children not requiring dialysis (76.0%), a lower mean (SD) Ca x PO4 product was observed (37.2, SD 2.3) compared to those requiring dialysis (41.5, SD 4.7; p<0.001). Hyperphosphatemia and hyperparathyroidism were more common in the dialysis group (66.7%) than in those not requiring dialysis (28.1% and 35.1%, respectively; p<0.05). Proteinuria was more prevalent in non-dialysis patients (89.5%) compared to dialysis patients (66.7%; p<0.05). Furthermore, LVH was significantly higher in the dialysis group (55.6%) compared to the non-dialysis group (21.1%; p<0.05). Children requiring dialysis exhibited higher LV mass, LVMI, and fractional shortening, indicating compromised cardiac function. Ejection fraction was also significantly lower in the dialysis group (51.7 vs. 60.9 in non-dialysis; p<0.05). Conclusion: These results underscore the intricate relationship between CKD, cardiovascular complications, and the impact of dialysis, emphasizing the need for tailored interventions to address the multifaceted challenges faced by children with CKD.
Abstract (English)
Objectives: To determine the proportion of children with chronic kidney disease requiring dialysis; and to determine the factors associated with children with CKD requiring or not requiring dialysis. Methods: This was a hospital based cross-sectional study with prospective enrolment of patients (children 1 to 18 years of age with chronic kidney disease (CKD, glomerular filtration rates less than 60 ml/min/1.73 m2)) conducted in the Department of Paediatrics, in a tertiary healthcare facility in central India between June 2020 and December 2021. Results: The majority of participants were males (81.3%), and three-quarters were aged ten or older. CKD stages varied, with 38.7% at stage 3, 40.0% at stage 4, and 21.3% at stage 5 and/or requiring dialysis. Several nutritional and hematologic abnormalities were observed, with 72.0% of children being underweight, 52.0% having anemia, and 42.7% presenting with proteinuria. Additionally, 46.7% exhibited abnormal calcium-phosphorus (Ca x PO4) product. The study reported a high prevalence of hypertension, with 22.7% having clinical hypertension and 90.7% having ambulatory hypertension. Metabolic disturbances were notable, including hyperkalaemia (17.3%) and acidosis (60.0%). Among children not requiring dialysis (76.0%), a lower mean (SD) Ca x PO4 product was observed (37.2, SD 2.3) compared to those requiring dialysis (41.5, SD 4.7; p<0.001). Hyperphosphatemia and hyperparathyroidism were more common in the dialysis group (66.7%) than in those not requiring dialysis (28.1% and 35.1%, respectively; p<0.05). Proteinuria was more prevalent in non-dialysis patients (89.5%) compared to dialysis patients (66.7%; p<0.05). Furthermore, LVH was significantly higher in the dialysis group (55.6%) compared to the non-dialysis group (21.1%; p<0.05). Children requiring dialysis exhibited higher LV mass, LVMI, and fractional shortening, indicating compromised cardiac function. Ejection fraction was also significantly lower in the dialysis group (51.7 vs. 60.9 in non-dialysis; p<0.05). Conclusion: These results underscore the intricate relationship between CKD, cardiovascular complications, and the impact of dialysis, emphasizing the need for tailored interventions to address the multifaceted challenges faced by children with CKD.
Files
IJPCR,Vol16,Issue2,Article60.pdf
Files
(384.0 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:6c65e129b2883281bc30f70eda65d50a
|
384.0 kB | Preview Download |
Additional details
Dates
- Accepted
-
2024-01-26
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue2,Article60.pdf
- Development Status
- Active
References
- 1. Varma PP. Prevalence of chronic kidney disease in India - Where are we heading? Indian J Nephrol. 2015; 25(3):133-5. 2. Rajapurkar M, Dabhi M. Burden of disease - prevalence and incidence of renal disease in India. Clin Nephrol. 2010; 74 Suppl 1:S9-12. 3. Trivedi H, Vanikar A, Patel H, Kanodia K, Kute V, Nigam L, et al. High prevalence of chronic kidney disease in a semi-urban population of Western India. Clin Kidney J. 2016; 9(3):438-43. 4. Becherucci F, Roperto RM, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J. 2016; 9(4):583-91. 5. Amanullah F, Malik AA, Zaidi Z. Chronic kidney disease causes and outcomes in children: Perspective from a LMIC setting. PLoS One. 2022; 17(6):e0269632. 6. Shroff R, Weaver DJ, Jr., Mitsnefes MM. Cardiovascular complications in children with chronic kidney disease. Nat Rev Nephrol. 2011;7(11):642-9. 7. Sun M, Wu X, Yu Y, Wang L, Xie D, Zhang Z, et al. Disorders of Calcium and Phosphorus Metabolism and the Proteomics/ Metabolomics-Based Research. Front Cell Dev Biol. 2020; 8:576110. 8. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012; 27(3):363-73. 9. Ghosh AK, Joshi SR. Disorders of calcium, phosphorus and magnesium metabolism. J Assoc Physicians India. 2008; 56:613-21. 10. Mitsnefes MM. Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol. 2012; 23(4):578-85. 11. Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, et al. Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Clin J Am Soc Nephrol. 2006; 1(5):1006-15. 12. Atkinson MA, Furth SL. Anemia in children with chronic kidney disease. Nat Rev Nephrol. 2011; 7(11):635-41. 13. Shroff R, Wan M, Gullett A, Ledermann S, Shute R, Knott C, et al. Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: a randomized trial. Clin J Am Soc Nephrol. 2012; 7(2):216-23. 14. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, et al. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension. 2008; 52(4):631-7. 15. Portale AA, Wolf M, Jüppner H, Messinger S, Kumar J, Wesseling-Perry K, et al. Disordered FGF23 and mineral metabolism in children with CKD. Clin J Am Soc Nephrol. 2014; 9(2):344-53. 16. Mitsnefes M, Flynn J, Cohn S, Samuels J, Blydt-Hansen T, Saland J, et al. Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol. 2010; 21(1):137-44. 17. Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, et al. Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr. 2006; 149(5):671-5. 18. Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A, Ingelfinger J. Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics. 2000; 105(6):1242-9. 19. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, et al. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012; 32 Suppl 2(Suppl 2):S32-86. 20. Warady BA, Abraham AG, Schwartz GJ, Wong CS, Muñoz A, Betoko A, et al. Predictors of Rapid Progression of Glomerular and Nonglomerular Kidney Disease in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort. Am J Kidney Dis. 2015; 65(6):878-88. 21. Schwartz GJ, Schneider MF, Maier PS, Moxey-Mims M, Dharnidharka VR, Warady BA, et al. Improved equations estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C. Kidney Int. 2012;82(4):445-53. 22. Tong A, Wong G, McTaggart S, Henning P, Mackie F, Carroll RP, et al. Quality of life of young adults and adolescents with chronic kidney disease. J Pediatr. 2013; 163(4):1179- 85.e5.23. Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco AL, De Jong PE, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney international supplements. 2013; 3(1):1-150. 24. Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006; 69(11):1945-53. 25. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208-18. 26. Nongnuch A, Panorchan K, Davenport A. Predialysis NTproBNP predicts magnitude of extracellular volume overload in haemodialysis patients. Am J Nephrol. 2014; 40(3):251-7. 27. Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Stancanelli B, et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int. 2004; 65(4):1492-8. 28. Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis. 1996; 27(3):347-54.