Cardiovascular Disease Risk Factors and Left Ventricular Hypertrophy in Girls and Boys With CKD

Abstract

Background and objectives: Prior studies suggested that women with CKD have higher risk for cardiovascular disease (CVD) and mortality than men, although putative mechanisms for this higher risk have not been identified. We assessed sex differences in (1) CVD risk factors and left ventricular hypertrophy (LVH), and (2) the relationship of left ventricular mass (LVM) with different measures of body size in children with CKD.

Design, setting, participants, and measurements: The study population comprised 681 children with CKD from the Chronic Kidney Disease in Children cohort, contributing 1330 visits. CVD risk factors were compared cross-sectionally by sex. LVH was defined as LVM/height2.7 >95th percentile and LVM relative to estimated lean body mass (eLBM) >95th percentile for age and sex. Differences in LVM by sex were assessed by adjusting for age, weight, height, and eLBM using bivariate and multivariate regression models.

Results: Girls were less likely to have uncontrolled hypertension (26% versus 38%, P=0.001), had lower diastolic BP z-scores (+0.3 versus +0.6, P=0.001), and had lower prevalence of high triglycerides (38% versus 47%, P=0.03) compared with boys. When LVH was defined by LVM indexed to height, girls had higher prevalence of LVH (16% versus 9%, P=0.01); when LVH was defined by LVM relative to eLBM, prevalence of LVH was similar between girls and boys (18% versus 17%, P=0.92). In regression models adjusting for eLBM, no sex differences in LVM were observed.

Conclusions: Despite lack of increased prevalence of CVD risk factors, indexing LVM to height showed a higher proportion of LVH among girls, while estimates of LVH based on eLBM showed no sex differences. Indexing LVM to eLBM may be an alternative to height indexing in children with CKD.

Keywords: Body Size; Body Weight; Humans; Hypertrophy, Left Ventricular; Male; Prevalence; Renal Insufficiency, Chronic; Sex Characteristics; Triglycerides; cardiovascular disease; child; chronic kidney disease; female; hypertension; left ventricular hypertrophy; pediatric nephrology; risk factors.

Copyright © 2016 by the American Society of Nephrology.

Figures

Figure 1.

Associations between left ventricular mass (LVM; in grams) and different metrics of body size show no difference in LVM by sex when adjusted for estimated lean body mass. Metrics include age, weight, height, and estimated lean body mass among 411 boys contributing 815 echocardiography studies and 270 girls contributing 515 echocardiography studies.