Lalayiannis Alexander D, Ferro Charles J, Wheeler David C, Duncan Neill D, Smith Colette, Popoola Joyce, Askiti Varvara, Mitsioni Andromachi, Kaur Amrit, Sinha Manish D, McGuirk Simon P, Mortensen Kristian H, Milford David V, Shroff Rukshana
University College London Great Ormond Street Hospital Institute of Child Health, London, UK.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Clin Kidney J. 2021 Sep 14;15(2):287-294. doi: 10.1093/ckj/sfab168. eCollection 2022 Feb.
Cardiovascular disease (CVD) is a common cause of morbidity and mortality even in young people with chronic kidney disease (CKD). We examined structural and functional CV changes in patients ˂30 years of age with CKD Stages 4 and 5 and on dialysis.
A total of 79 children and 21 young adults underwent cardiac computed tomography for coronary artery calcification (CAC), ultrasound for carotid intima-media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV) and echocardiography. Differences in structural (CAC, cIMT -score, left ventricular mass index) and functional (carotid distensibility -score and cfPWV -score) measures were examined between CKD Stages 4 and 5 and dialysis patients.
Overall, the cIMT -score was elevated [median 2.17 (interquartile range 1.14-2.86)] and 10 (10%) had CAC. A total of 16/23 (69.5%) patients with CKD Stages 4 and 5 and 68/77 (88.3%) on dialysis had at least one structural or functional CV abnormality. There was no difference in the prevalence of structural abnormalities in CKD or dialysis cohorts, but functional abnormalities were more prevalent in patients on dialysis (P < 0.05). The presence of more than one structural abnormality was associated with a 4.5-fold increased odds of more than one functional abnormality (95% confidence interval 1.3-16.6; P < 0.05). Patients with structural and functional abnormalities [cIMT -score >2 standard deviation (SD) or distensibility <-2 SD) had less carotid dilatation (lumen:wall cross-sectional area ratio) compared with those with normal cIMT and distensibility.
There is a high burden of subclinical CVD in young CKD patients, with a greater prevalence of functional abnormalities in dialysis compared with CKD patients. Longitudinal studies are required to test these hypothesis-generating data and define the trajectory of CV changes in CKD.
心血管疾病（CVD）即使在患有慢性肾脏病（CKD）的年轻人中也是发病和死亡的常见原因。我们研究了年龄小于30岁、处于CKD 4期和5期且正在接受透析的患者的心血管结构和功能变化。
共有79名儿童和21名年轻成年人接受了心脏计算机断层扫描以检测冠状动脉钙化（CAC），接受了超声检查以测量颈动脉内膜中层厚度（cIMT）、颈股脉搏波速度（cfPWV）并进行了超声心动图检查。研究了CKD 4期和5期患者与透析患者在结构（CAC、cIMT评分、左心室质量指数）和功能（颈动脉扩张性评分和cfPWV评分）指标上的差异。
总体而言，cIMT评分升高[中位数2.17（四分位间距1.14 - 2.86）]，10名（10%）患者有CAC。共有16/23（69.5%）的CKD 4期和5期患者以及68/77（88.3%）的透析患者至少有一项心血管结构或功能异常。CKD组和透析组结构异常的患病率无差异，但功能异常在透析患者中更为普遍（P < 0.05）。存在一项以上结构异常与一项以上功能异常的几率增加4.5倍相关（95%置信区间1.3 - 16.6；P < 0.05）。与cIMT和扩张性正常的患者相比，存在结构和功能异常[cIMT评分>2标准差（SD）或扩张性<-2 SD]的患者颈动脉扩张较少（管腔：壁横截面积比）。
年轻CKD患者亚临床CVD负担较重，与CKD患者相比，透析患者功能异常的患病率更高。需要进行纵向研究来验证这些产生假设的数据，并确定CKD中心血管变化的轨迹。
