Kaddourah Ahmad, Uthup Susan, Madueme Peace, O'Rourke Matthew, Hooper David K, Taylor Michael D, Colan Steven D, Jefferies John L, Rao Marepalli B, Goebel Jens
Clin Nephrol. 2015 May;83(5):262-71. doi: 10.5414/CN108489.
Cardiovascular disease is the leading cause of death in children with end-stage renal disease (ESRD). Isolated aortic dilation (AD) is rare in children. We aimed to determine the prevalence and the risk factors for AD in children with ESRD.
We reviewed records of all ESRD patients followed mat our institution from January 2007 to October 2012. AD was defined as Z-score > 2 in the dimension of at least one of the following echocardiographic aortic parameters: annulus, root at the sinus, sino-tubular junction, or ascending aorta.
The records of 78 patients on dialysis and 19 kidney transplant recipients were available. 30 patients (30.9%) had AD. Multivariate analysis revealed independent associations of AD with body mass index (BMI) Z-score (OR = 0.52, 95% confidence interval (CI): 0.35 - 0.78) and ESRD secondary to glomerular disease (OR = 4.58, 95% CI: 1.45 - 14.46). We developed a classification and regression tree (CART) model to identify patients at low vs. high AD risk. Our model classified 62 patients of the cohort (64%) to be high- or lowrisk, with a positive predictive value of 89% and a negative predictive value of 100%.
Our data suggest that AD, as a possible marker of aortopathy and early aneurysm formation, is a novel and prevalent cardiovascular complication in ESRD children. Glomerular disease and low BMI Zscore appear to be potent predictors. CART modeling helps identify high-risk children, potentially guiding decisions regarding targeted echocardiographic evaluations.
心血管疾病是终末期肾病（ESRD）患儿的主要死因。孤立性主动脉扩张（AD）在儿童中较为罕见。我们旨在确定ESRD患儿中AD的患病率及危险因素。
我们回顾了2007年1月至2012年10月在我院随访的所有ESRD患者的记录。AD定义为以下至少一项超声心动图主动脉参数维度的Z评分>2：瓣环、窦部根部、窦管交界或升主动脉。
有78例透析患者和19例肾移植受者的记录可供分析。30例患者（30.9%）存在AD。多变量分析显示AD与体重指数（BMI）Z评分（OR = 0.52，95%置信区间（CI）：0.35 - 0.78）以及肾小球疾病继发的ESRD（OR = 4.58，95%CI：1.45 - 14.46）独立相关。我们开发了一种分类回归树（CART）模型来识别AD低风险和高风险患者。我们的模型将队列中的62例患者（64%）分类为高风险或低风险，阳性预测值为89%，阴性预测值为100%。
我们的数据表明，AD作为主动脉病变和早期动脉瘤形成的可能标志物，是ESRD儿童中一种新的且普遍存在的心血管并发症。肾小球疾病和低BMI Z评分似乎是有力的预测因素。CART建模有助于识别高风险儿童，可能指导有关针对性超声心动图评估的决策。
