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儿童和青少年终末期肾病患者的心血管风险。

Cardiovascular risk in children and adolescents with end stage renal disease.

机构信息

Departamento de Pediatra, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR.

Graduacao, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR.

出版信息

Clinics (Sao Paulo). 2019;74:e859. doi: 10.6061/clinics/2019/e859. Epub 2019 Jun 19.

Abstract

OBJECTIVES

To evaluate cardiovascular involvement in children and adolescents with End Stage Renal Disease (ESRD) and to characterize the main risk factors associated with this outcome.

METHODS

Cross-sectional study of 69 children and adolescents at renal transplantation and 33 healthy individuals matched by age and gender. The study outcomes were left ventricular mass z-score (LVMZ) and carotid artery intima-media thickness (CIMT). The potential risk factors considered were age, gender, CKD etiology, use of oral vitamin D and calcium-based phosphate binders, systolic and diastolic blood pressure, body mass index z-score, time since diagnosis, dialysis duration, serum levels of ionic calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF 23), uric acid, homocysteine, cholesterol, triglycerides, C-reactive protein (CRP), vitamin D and hemoglobin.

RESULTS

In the multivariate analysis, the factors associated with LVMZ were dialysis duration, age, systolic blood pressure, serum hemoglobin and HDL cholesterol levels. Regarding CIMT, in the multivariate analysis, systolic blood pressure was the only factor associated with the outcome.

CONCLUSION

Children exhibited important cardiovascular involvement at the time of the renal transplantation. Both of the studied outcomes were independently associated with systolic blood pressure. For this reason, controlling blood pressure seems to be the main therapy to minimize cardiovascular involvement in children with ESRD.

摘要

目的

评估终末期肾病(ESRD)患儿和青少年的心血管受累情况,并确定与该结果相关的主要危险因素。

方法

对 69 名接受肾移植的儿童和青少年以及 33 名年龄和性别相匹配的健康个体进行横断面研究。研究结果为左心室质量 z 评分(LVMZ)和颈动脉内膜中层厚度(CIMT)。考虑的潜在危险因素包括年龄、性别、CKD 病因、口服维生素 D 和钙基磷结合剂的使用、收缩压和舒张压、体重指数 z 评分、诊断后时间、透析持续时间、血清离子钙、磷、甲状旁腺激素、成纤维细胞生长因子(FGF 23)、尿酸、同型半胱氨酸、胆固醇、甘油三酯、C 反应蛋白(CRP)、维生素 D 和血红蛋白水平。

结果

在多变量分析中,与 LVMZ 相关的因素是透析持续时间、年龄、收缩压、血清血红蛋白和高密度脂蛋白胆固醇水平。关于 CIMT,在多变量分析中,收缩压是唯一与该结果相关的因素。

结论

儿童在接受肾移植时已存在重要的心血管受累。这两个研究结果均与收缩压独立相关。因此,控制血压似乎是减少 ESRD 儿童心血管受累的主要治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/865e/6558996/8b7a8aee1dfe/cln-74-e859-g001.jpg

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