Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Clin J Am Soc Nephrol. 2011 Sep;6(9):2132-40. doi: 10.2215/CJN.07100810. Epub 2011 Aug 12.
Metabolic abnormalities and cardiovascular disease (CVD) risk factors have rarely been systematically assessed in children with chronic kidney disease (CKD). We examined the prevalence of various CKD sequelae across the GFR spectrum.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were used from 586 children participating in the Chronic Kidney Disease in Children (CKiD) study (United States and Canada) with GFR measured by iohexol plasma disappearance. Laboratory values and CVD risk factors were compared across GFR categories and with an age-, gender-, and race-matched community sample.
CKiD participants were 62% male, 66% Caucasian, 23% African American, and 15% Hispanic with a median age of 11 years and a median GFR of 44 ml/min per 1.73 m(2). Compared with those with a GFR ≥ 50 ml/min per 1.73 m(2), having a GFR < 30 ml/min per 1.73 m(2) was associated with a three-fold higher risk of acidosis and growth failure and a four- to five-fold higher risk of anemia and elevated potassium and phosphate. Median GFR change was -4.3 ml/min per 1.73 m(2) and -1.5 ml/min per 1.73 m(2) per year in children with glomerular and nonglomerular diagnoses, respectively. Despite medication and access to nephrology care, uncontrolled systolic hypertension was present in 14%, and 16% had left ventricular hypertrophy. Children with CKD frequently were also shorter and had lower birth weight, on average, compared with norms.
Growth failure, metabolic abnormalities, and CVD risk factors are present at GFR >50 ml/min per 1.73 m(2) in children with CKD and, despite therapy, increase in prevalence two- to four-fold with decreasing GFR.
代谢异常和心血管疾病（CVD）危险因素在慢性肾脏病（CKD）患儿中很少被系统评估。我们检查了在 GFR 谱中各种 CKD 后果的患病率。
设计、地点、参与者和测量：使用了来自 586 名参与慢性肾脏病儿童（CKiD）研究（美国和加拿大）的数据，GFR 通过碘海醇血浆清除率测量。将实验室值和 CVD 危险因素与 GFR 类别进行比较，并与年龄、性别和种族匹配的社区样本进行比较。
CKiD 参与者中，62%为男性，66%为白种人，23%为非裔美国人，15%为西班牙裔，中位年龄为 11 岁，中位 GFR 为 44 ml/min/1.73 m²。与 GFR≥50 ml/min/1.73 m²的患者相比，GFR<30 ml/min/1.73 m²与酸中毒和生长不良的风险增加三倍以及贫血和血钾、血磷升高的风险增加四到五倍相关。肾小球和非肾小球诊断患儿的中位 GFR 变化分别为-4.3 ml/min/1.73 m²和-1.5 ml/min/1.73 m²/年。尽管进行了药物治疗并接受了肾病学治疗，但仍有 14%的患儿存在未控制的收缩期高血压，16%的患儿存在左心室肥厚。与正常值相比，CKD 患儿的平均身高和出生体重也较低。
生长不良、代谢异常和 CVD 危险因素在 GFR>50 ml/min/1.73 m²的 CKD 患儿中就已存在，并且尽管进行了治疗，但随着 GFR 的降低，患病率仍增加了两到四倍。
