Division of Nephrology and Hypertension, J.W. Riley Hospital for Children, Indianapolis, IN 46202, USA.
Clin J Am Soc Nephrol. 2011 Dec;6(12):2759-65. doi: 10.2215/CJN.03010311. Epub 2011 Oct 6.
Although prevalence of traditional cardiovascular risk factors (CVRF) has been described in children with CKD, the frequency with which these CVRF occur concomitantly and the clinical characteristics associated with multiple CVRF are unknown. This study determined the prevalence and characteristics of multiple CVRF in children in the Chronic Kidney Disease in Children study.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using cross-sectional data from first follow-up visits, we determined the prevalence of four CVRF: hypertension (casual BP >95(th) percentile or self-reported hypertension with concurrent use of anti-hypertensive medication), dyslipidemia (triglycerides >130 mg/dl, HDL <40 mg/dl, non-HDL >160 mg/dl, or use of lipid-lowering medication), obesity (BMI >95(th) percentile), and abnormal glucose metabolism (fasting glucose >110 mg/dl, insulin >20 μIU/ml, or HOMA-IR >2.20, >3.61, or >3.64 for those at Tanner stage 1, 2 to 3, or 4 to 5, respectively) in 250 children (median age 12.2 years, 74% Caucasian, median iohexol-based GFR 45.2 ml/min per 1.73 m(2)).
Forty-six percent had hypertension, 44% had dyslipidemia, 15% were obese, and 21% had abnormal glucose metabolism. Thirty-nine percent, 22%, and 13% had one, two, and three or more CVRF, respectively. In multivariate ordinal logistic regression analysis, glomerular disease and nephrotic-range proteinuria were associated with 1.96 (95% confidence interval, 1.04 to 3.72) and 2.04 (95% confidence interval, 0.94 to 4.43) higher odds of having more CVRF, respectively.
We found high prevalence of multiple CVRF in children with mild to moderate CKD. Children with glomerular disease may be at higher risk for future cardiovascular events.
尽管已经描述了慢性肾脏病（CKD）患儿中传统心血管危险因素（CVRF）的患病率，但同时发生这些 CVRF 的频率以及与多种 CVRF 相关的临床特征尚不清楚。本研究旨在确定慢性肾脏病儿童研究中首次随访时儿童中多种 CVRF 的患病率和特征。
设计、地点、参与者和测量：使用首次随访时的横断面数据，我们确定了四种 CVRF 的患病率：高血压（偶然血压>第 95 百分位或自述高血压同时使用抗高血压药物）、血脂异常（甘油三酯> 130mg/dl，HDL<40mg/dl，非-HDL>160mg/dl，或使用降脂药物）、肥胖（BMI>第 95 百分位）和异常葡萄糖代谢（空腹血糖> 110mg/dl，胰岛素> 20μIU/ml，或 HOMA-IR> 2.20、3.61 或 3.64，分别用于 Tanner 分期 1、2 至 3 或 4 至 5 的个体），纳入 250 名儿童（中位年龄 12.2 岁，74%为白种人，中位 iohexol 基于 GFR 为 45.2ml/min/1.73m2）。
46%的患儿患有高血压，44%的患儿患有血脂异常，15%的患儿肥胖，21%的患儿葡萄糖代谢异常。39%、22%和 13%的患儿分别有 1、2 和 3 种或更多 CVRF。在多变量有序逻辑回归分析中，肾小球疾病和肾病范围蛋白尿与 1.96（95%置信区间，1.04 至 3.72）和 2.04（95%置信区间，0.94 至 4.43）更高的存在更多 CVRF 的可能性相关。
我们发现患有轻度至中度 CKD 的儿童中存在多种 CVRF 的高患病率。肾小球疾病患儿可能有更高的未来心血管事件风险。
