Clothier Joanna C, Simpson John M, Turner Charles, Dalton R Neil, Rasmussen Pernille, Rawlins Debbie, Booth Caroline J, Peacock Janet L, Sinha Manish D
Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
Nephron Clin Pract. 2013;124(3-4):191-201. doi: 10.1159/000356385. Epub 2014 Jan 4.
Children with chronic kidney disease (CKD) are at increased risk of future cardiovascular (CV) events. Our aim in this prospective single-centre cross-sectional analysis was to assess the relationship of a novel panel of CV biomarkers with left ventricular hypertrophy (LVH).
A panel of five CV biomarkers (asymmetric dimethyl arginine, high sensitivity C-reactive protein, homocysteine, N-terminal pro-B type natriuretic peptide and uric acid) were measured on the same day as an echocardiogram assessment, in paediatric patients with pre-dialysis stages 3-5 of CKD.
Of 73 children aged 5-18 years, LVH, all eccentric, was identified in 38%. Systolic blood pressure (BP), glomerular filtration rate (GFR) and higher intake of calcium-based phosphate binders were significantly worse in children with LVH. In multivariate models analysing each biomarker one at a time with confounders [GFR, systolic BP z-score, anti-hypertensive medication (yes/no) and elemental calcium intake], clinic systolic BP z-score and elemental calcium intake consistently displayed a significant relationship with indexed left ventricular mass (LVMI). None of the evaluated CV biomarkers displayed a significant relationship with LVMI.
In our cohort of children with moderately severe pre-dialysis CKD we have identified no suitable biomarkers to detect LVH. We would therefore recommend that echocardiographic determination of LVMI remains the technique of choice for detection of LVH in children with CKD.
慢性肾脏病（CKD）患儿未来发生心血管（CV）事件的风险增加。在这项前瞻性单中心横断面分析中，我们的目的是评估一组新型CV生物标志物与左心室肥厚（LVH）之间的关系。
在对处于CKD透析前3 - 5期的儿科患者进行超声心动图评估的同一天，检测一组五种CV生物标志物（不对称二甲基精氨酸、高敏C反应蛋白、同型半胱氨酸、N末端B型利钠肽原和尿酸）。
在73名5 - 18岁的儿童中，38%被发现存在LVH，均为离心性肥厚。LVH患儿的收缩压（BP）、肾小球滤过率（GFR）以及钙基磷结合剂的摄入量明显更差。在多变量模型中，每次分析一种生物标志物并纳入混杂因素[GFR、收缩压z评分、抗高血压药物使用情况（是/否）和元素钙摄入量]，临床收缩压z评分和元素钙摄入量始终与左心室质量指数（LVMI）显示出显著关系。所评估的CV生物标志物均与LVMI无显著关系。
在我们的中度严重CKD透析前患儿队列中，我们未发现适合检测LVH的生物标志物。因此，我们建议超声心动图测定LVMI仍然是检测CKD患儿LVH的首选技术。
