Departamento de Nefrologia, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
Pediatr Nephrol. 2012 Sep;27(9):1557-64. doi: 10.1007/s00467-012-2173-1. Epub 2012 May 3.
Uremic vasculopathy, including vascular calcification, increases the risk for cardiovascular disease and mortality in chronic kidney disease (CKD) patients. We have investigated the prevalence and factors associated with vasculopathy in children undergoing peritoneal dialysis (PD) or hemodialysis (HD) in a single center.
Common carotid intima media thickness (cIMT) and its relation with demographics, biochemical parameters and medication was analyzed in 60 patients (mean age 12.9 ± 3.4 years; 27 girls) treated with PD (n = 31) or HD (n = 29) for 34 ± 34 months. Patients were divided into two groups: normal cIMT and increased cIMT.
Mean levels of calcium, phosphate and calcium/phosphate product were in the normal range, the but parathyroid hormone level, 729 ± 670 pg/mL, was higher than the National Kidney Foundation Kidney Disease Outcome Quality Iniative (K/DOQI) recommendations. Twenty-nine patients had increased cIMT, which was associated with time on dialysis of >2 years, hypercalcemia, higher daily dose of calcitriol and HD (vs. PD). In the multivariate analysis, accounting for time on dialysis, HD persisted as a risk for increased cIMT.
The prevalence of increased cIMT in children on dialysis is similar to that reported in adults with CKD and increased with time on dialysis. HD was associated with increased cIMT, independently of time on dialysis; however, the results should be interpreted with caution due to the possible impact of confounding factors. These results underline the need to monitor and, if possible, prevent and treat increased cIMT in children on dialysis.
尿毒症血管病变，包括血管钙化，增加了心血管疾病的风险和慢性肾脏病（CKD）患者的死亡率。我们已经调查了在一个单一的中心接受腹膜透析（PD）或血液透析（HD）的儿童中血管病变的患病率和相关因素。
分析了 60 例患者（平均年龄 12.9 ± 3.4 岁；27 名女性）的颈总动脉内膜中层厚度（cIMT）及其与人口统计学、生化参数和药物的关系，这些患者接受 PD（n = 31）或 HD（n = 29）治疗 34 ± 34 个月。患者分为两组：正常 cIMT 和增加的 cIMT。
钙、磷和钙/磷产物的平均水平在正常范围内，但甲状旁腺激素水平为 729 ± 670 pg/ml，高于国家肾脏基金会肾脏病结局质量倡议（K/DOQI）的建议。29 例患者的 cIMT 增加，与透析时间>2 年、高钙血症、更高的骨化三醇日剂量和 HD（与 PD 相比）有关。在多变量分析中，考虑到透析时间，HD 仍然是增加 cIMT 的危险因素。
在接受透析的儿童中，增加的 cIMT 的患病率与 CKD 成人报告的患病率相似，并随着透析时间的延长而增加。HD 与 cIMT 增加有关，独立于透析时间；然而，由于混杂因素的可能影响，结果应谨慎解释。这些结果强调了需要监测并在可能的情况下预防和治疗接受透析的儿童中增加的 cIMT。
