Pediatric CKD and cardiovascular disease.

Children and adolescents with chronic kidney disease (CKD) are at high risk for cardiovascular morbidity and mortality. This review provides a comprehensive overview of the possible risk factors for early atherosclerosis in children with CKD. Endothelial dysfunction, a precursor of atherosclerosis, starts early in renal disease, as indicated by increased carotid artery intima media thickness, carotid arterial wall stiffness, impaired flow mediated dilatation, and coronary artery calcification, which are frequently present in children with CKD. Many risk factors for atherosclerosis, such as hypertension, dyslipidemia, renal bone disease, hyperhomocysteinemia, and uremia-related cardiovascular risk factors are associated with CKD. All of these risk factors are modifiable and optimal clinical management can delay or prevent cardiovascular disease. Another strategy to decrease the risk of premature cardiac disease and death in children with CKD is to slow the progression of renal disease.