Doyon Anke, Hofstetter Jonas, Bayazit Aysun Karabay, Azukaitis Karolis, Niemirska Ana, Civilibal Mahmut, Kaplan Bulut Ipek, Duzova Ali, Oguz Berna, Ranchin Bruno, Shroff Rukshana, Bilginer Yelda, Caliskan Salim, Paripovic Dusan, Candan Cengiz, Yilmaz Alev, Harambat Jerome, Özçakar Zeynep Birsin, Lugani Francesca, Alpay Harika, Tschumi Sibylle, Yilmaz Ebru, Drozdz Dorota, Tabel Yilmaz, Özcelik Gül, Caldas Afonso Alberto, Yavascan Onder, Melk Anette, Querfeld Uwe, Schaefer Franz
Pediatric Nephrology Division Center for Pediatrics and Adolescent Medicine Heidelberg Germany.
Department of Pediatric Nephrology Çukurova University, Faculty of Medicine Adana Turkey.
J Am Heart Assoc. 2025 Apr;14(7):e037563. doi: 10.1161/JAHA.124.037563. Epub 2025 Mar 26.
Carotid intima-media thickness (cIMT) may identify early alterations in the vascular phenotype in children with chronic kidney disease (CKD).
Investigation of longitudinal changes in cIMT SD scores (SDS) in 670 patients from the 4C Study (Cardiovascular Comorbidity in Children With CKD Study), aged 6 to 17 years, with CKD stage 3 to 5 at baseline. The longitudinal trajectory of cIMT SDS over up to 8 years was examined using a longitudinal mixed-effects model. The yearly progression rate in cIMT SDS (β=0.20 [95% CI, 0.13-0.28]) remained positive during the initial 4.5-year follow-up period but slowed down quadratically with increasing observation time (β=-0.02 [95% CI, -0.03 to -0.01]). Risk factors for increased cIMT SDS included time since baseline, younger age, higher height SDS, female sex, elevated diastolic blood pressure, and lower serum albumin, but not estimated glomerular filtration rate. In patients with progressive CKD, higher albuminuria was additionally associated with an increase in cIMT SDS. In patients with stable CKD, serum phosphate and time were the only risk factors identified for elevated cIMT SDS. Annual rates of change in blood pressure were positively correlated with the rate of change in cIMT SDS within the first 4.5 years (for systolic: β=0.42 [95% CI, 0.22-0.62]; for diastolic: β=1.56 [95% CI, 1.01-2.11]).
The results show a significant longitudinal increase in cIMT SDS in children with CKD. Changes in blood pressure are associated with the progression of cIMT SDS, suggesting a relevant impact of blood pressure modulation on cIMT SDS.
颈动脉内膜中层厚度（cIMT）可能有助于识别慢性肾脏病（CKD）患儿血管表型的早期改变。
对4C研究（CKD患儿心血管合并症研究）中670例6至17岁、基线时处于CKD 3至5期的患者的cIMT标准差分数（SDS）的纵向变化进行调查。使用纵向混合效应模型检查了长达8年的cIMT SDS纵向轨迹。在最初4.5年的随访期内，cIMT SDS的年进展率（β=0.20 [95%CI，0.13 - 0.28]）保持为正值，但随着观察时间的增加呈二次方减缓（β=-0.02 [95%CI，-0.03至-0.01]）。cIMT SDS增加的危险因素包括自基线起的时间、较年轻的年龄、较高的身高SDS、女性、舒张压升高和较低的血清白蛋白，但不包括估计的肾小球滤过率。在进行性CKD患者中，较高的蛋白尿还与cIMT SDS增加有关。在稳定CKD患者中，血清磷酸盐和时间是cIMT SDS升高的仅有的危险因素。在最初4.5年内，血压的年变化率与cIMT SDS的变化率呈正相关（收缩压：β=0.42 [95%CI，0.22 - 0.62]；舒张压：β=1.56 [95%CI，1.01 - 2.11]）。
结果显示CKD患儿的cIMT SDS有显著的纵向增加。血压变化与cIMT SDS的进展相关，提示血压调节对cIMT SDS有重要影响。
