Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.
Transplantation. 2024 May 1;108(5):1212-1219. doi: 10.1097/TP.0000000000004881. Epub 2024 Apr 24.
Children requiring kidney replacement therapy experience high burden of cardiovascular (CV) disease leading to increased mortality. Intima-media thickness (IMT) indicating atherosclerosis is a validated surrogate marker for future CV events.
We investigated the effect of different treatment modalities (dialysis, preemptive kidney transplantation (KTx), late KTx after dialysis) on IMT by multivariable linear mixed-effect modeling. Patients were enrolled in a prospective cohort study.
A total of 261 analyzed children had a mean follow-up of 3 y. Children after preemptive and late KTx had lower levels of IMT when compared with dialysis. Using an interaction term, a significant progression of IMT over time was seen during dialysis (β = 0.0053 mm/y, P = 0.004). IMT before the start of therapy was the most influential determinant in all models. Low IMT was associated with maintenance steroid treatment after preemptive KTx. High IMT on dialysis was associated with higher systolic blood pressure, lower body mass index, lower serum albumin, and lower bicarbonate.
IMT remained rather stable in children several years after KTx. In contrast, children on dialysis had higher IMT values, which increased over time. In these children, blood pressure control, calorie and protein intake, and acid-base homeostasis seem important. Taken together, children might profit from early transplantation to limit accumulation of CV risk.
需要肾脏替代治疗的儿童患有心血管（CV）疾病的负担很高，导致死亡率增加。动脉粥样硬化的内膜-中层厚度（IMT）是未来 CV 事件的有效替代标志物。
我们通过多变量线性混合效应模型研究了不同治疗方式（透析、预防性肾移植（KTx）、透析后晚期 KTx）对 IMT 的影响。患者被纳入前瞻性队列研究。
共分析了 261 例患儿，平均随访 3 年。与透析相比，预防性和晚期 KTx 后的患儿 IMT 水平较低。使用交互项，在透析期间观察到 IMT 随时间显著进展（β=0.0053mm/y，P=0.004）。治疗前的 IMT 是所有模型中最具影响力的决定因素。预防性 KTx 后维持类固醇治疗与低 IMT 相关。透析时高 IMT 与较高的收缩压、较低的体重指数、较低的血清白蛋白和较低的碳酸氢盐相关。
KTx 后数年，儿童的 IMT 仍相对稳定。相比之下，透析的儿童 IMT 值较高，且随时间增加。在这些儿童中，血压控制、热量和蛋白质摄入以及酸碱平衡似乎很重要。综上所述，儿童可能受益于早期移植以限制 CV 风险的积累。
