Aortic dilatation in children with mild to moderate chronic kidney disease

Abstract

Background: Children with mild to moderate chronic kidney disease are at an increased risk for cardiovascular sequelae, the leading cause of death in children with end-stage renal disease. We aimed to establish the prevalence of aortic dilatation, a newly recognized cardiovascular sequelae of renal disease, within a cohort of pediatric patients with mild to moderate kidney disease.

Methods: A total of 501 children enrolled in the Chronic Kidney Disease in Children study contributed imaging data between April 2011 and February 2015. Aortic dilatation was defined as a dimension exceeding a z-score of 2 at any of three locations: aortic root, sinotubular junction, or the ascending aorta.

Results: At baseline echocardiographic evaluation, 30 (6%) children were identified to have aortic dilatation in at least one of the three locations. Multivariate analysis demonstrated an increased odds ratio for the presence of aortic dilatation associated with the following variables: high diastolic blood pressure z-scores, low weight z-score, and low body mass index z-score. Presense of protein energy wasting (modified definition, OR 2.41, 95%CI 1.23, 4.70) was the strongest independent predictor of aortic dilatation.

Conclusion: In conclusion, aortic dilatation does occur early in the course of chronic kidney disease and associates with markers of poor nutrition. Future studies should continue to evaluate these risk factors longitudinally as the kidney disease progresses.

Keywords: Aortic dilatation; Cardiovascular disease; Chronic kidney disease; Malnutrition; Protein energy wasting.

Conflict of interest statement

Disclosures

None of the authors have a conflict of interest or any disclosures to report.

Figures

Figure 1.

Inner edge to inner edge technique at end-systole for assessment of the aortic root.

Figure 2.

Unadjusted and adjusted association of cardiovascular, CKD severity and body size variables with aortic root, ST junction and ascending z-scores. Associations are interpreted as the change in aortic z-scores (standard deviation) associated with a one standard deviation change in continuous variables, or the presence of binary variables compared to the absence (for example, the difference in aortic z-score comparing those with low hemoglobin to those with normal hemoglobin). Associations are described by unadjusted (○) and adjusted (●) analyses with 95% confidence intervals. Adjusted analyses controlled for age, years with kidney disease, antihypertensive therapy, growth hormone therapy and low hemoglobin. Significant adjusted estimates are denoted by *.