Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
Division of Nephrology, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA.
Pediatr Nephrol. 2019 Aug;34(8):1403-1412. doi: 10.1007/s00467-019-04229-3. Epub 2019 Mar 22.
The aims were to compare the cardiovascular disease (CVD) risk among children with chronic kidney disease (CKD) secondary to focal segmental glomerulosclerosis (FSGS) with the CVD risk of children with CKD due to other diagnoses.
Casual blood pressure (BP), ambulatory blood pressure monitoring (APBM), echocardiogram, lipids, carotid intima medial thickness (cIMT), and uric acid obtained from participants in the Chronic Kidney Disease in Children (CKiD) cohort were analyzed longitudinally. Seventy-nine children with FSGS (FSGS-CKD) were compared to 196 children with non-FSGS glomerular disease (GDO-CKD) and 616 children with non-glomerular disease (NG-CKD).
At baseline, FSGS-CKD (median 14 years) had ambulatory hypertension (24.6%), masked hypertension (46.2%), left ventricular hypertrophy (LVH) (26.3%), and dyslipidemia (60.0%). In adjusted models, FSGS-CKD had higher systolic BP z-score (0.52 vs 0.11 and 0.23, p = 0.002 and 0.02), triglycerides (133 vs 109 and 102 mg/dl, p = 0.007 and < 0.001), and non-high density lipoprotein (144 vs 132 and 119 mg/dl, p = 0.07 and < 0.001) at baseline when compared to GDO-CKD and NG-CKD, respectively. Left ventricular mass index (LVMI) (36.0 vs 31.7 g/m, p < 0.001) and the odds of LVH (OR 3.38, 95% CI 1.42, 8.08) at baseline were greater in FSGS-CKD compared to NG-CKD. Adjusted longitudinal analysis showed that FSGS-CKD had a faster decline in LVMI than NG-CKD, and FSGS-CKD had a faster increase in uric acid compared to both groups.
Children with CKD due to FSGS had a relatively high prevalence of CVD risk factors. FSGS was associated with greater CVD risk when compared to other CKD diagnoses.
本研究旨在比较继发于局灶节段性肾小球硬化（FSGS）的儿童慢性肾脏病（CKD）与其他病因导致 CKD 的儿童的心血管疾病（CVD）风险。
对慢性肾脏病儿童（CKiD）队列参与者的偶测血压（BP）、动态血压监测（ABPM）、超声心动图、血脂、颈动脉内膜中层厚度（cIMT）和尿酸进行了纵向分析。将 79 例 FSGS 所致 CKD（FSGS-CKD）患儿与 196 例非 FSGS 肾小球疾病所致 CKD（GDO-CKD）患儿和 616 例非肾小球疾病所致 CKD（NG-CKD）患儿进行比较。
基线时，FSGS-CKD（中位年龄 14 岁）存在动态血压升高（24.6%）、隐匿性高血压（46.2%）、左心室肥厚（LVH）（26.3%）和血脂异常（60.0%）。在调整后的模型中，FSGS-CKD 的收缩压 z 评分更高（0.52 比 0.11 和 0.23，p=0.002 和 0.02）、三酰甘油（133 比 109 和 102mg/dl，p=0.007 和 <0.001）和非高密度脂蛋白（144 比 132 和 119mg/dl，p=0.07 和 <0.001），分别与 GDO-CKD 和 NG-CKD 相比。FSGS-CKD 的左心室质量指数（LVMI）（36.0 比 31.7g/m2，p<0.001）和 LVH 的比值比（OR）（3.38，95%CI 1.42，8.08）在基线时均高于 NG-CKD。调整后的纵向分析显示，FSGS-CKD 的 LVMI 下降速度快于 NG-CKD，FSGS-CKD 的尿酸增加速度快于其他两组。
FSGS 所致 CKD 患儿 CVD 危险因素的患病率相对较高。与其他 CKD 诊断相比，FSGS 与更大的 CVD 风险相关。
