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      Longitudinal follow‐up on vascular morphology and function in children with kidney transplants

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          Abstract

          Aim

          Our aim was to evaluate cardiovascular risk profile in 42 children with kidney transplants (KT) at the Queen Silvia Children's Hospital, Gothenburg Sweden.

          Methods

          Forty‐two children (7.1–18 years) with KT, time from transplantation 3.5 (0.9–13) years, were examined at inclusion and annually for three consecutive years. Eighteen matched controls were examined once. Cardiovascular phenotyping included ultra‐high‐frequency ultrasound (UHFUS), pulse wave velocity (PWV), and endothelial function.

          Results

          Children with KT had higher body mass index (BMI) z‐score and blood pressure (BP) z‐score than healthy controls (BMI z‐score: 0.4 ± 1.0 and − 0.2 ± 0.9, respectively, p = 0.02; SBP z‐score: 0.5  ± 0.9 and − 0.8  ± 0.7; DBP z‐score: 0.7  ± 0.7 and − 0.3  ± 0.5, respectively, p < 0.001). BP z‐score decreased significantly over 3 years; other vascular markers remained unchanged. PWV and carotid intima thickness (IT) were higher in children with KT compared to healthy controls. Children with pre‐emptive KT had lower radial IT and dorsal pedal media thickness (MT) compared to children with preceding dialysis.

          Conclusion

          Children with KT show increased cardiovascular risk parameters, not increasing over time. Children on dialysis before KT have more pronounced vascular changes than those with pre‐emptive KT, suggesting pre‐emptive transplantation more beneficial for cardiovascular health.

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          Most cited references34

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          Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

          Joseph T Flynn, David Kaelber, Carissa Baker-Smith … (2017)
          These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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            Hypertension in CKD: Core Curriculum 2019

            Elaine Ku, Benjamin J Lee, Jenny J Wei … (2019)
            Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologic states, such that sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can conversely lead to worsening blood pressure (BP) control. The pathophysiology of hypertension in CKD is complex and is a sequela of multiple factors, including reduced nephron mass, increased sodium retention and extracellular volume expansion, sympathetic nervous system overactivity, activation of hormones including the renin-angiotensin-aldosterone system, and endothelial dysfunction. Currently, the treatment target for patients with CKD is a clinic systolic BP < 130mm Hg. The main approaches to the management of hypertension in CKD include dietary salt restriction, initiation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic therapy. Uncontrolled hypertension can lead to significant cardiovascular morbidity and mortality and accelerate progression to end-stage kidney disease. Although intensive BP control has not been shown in clinical trials to slow the progression of CKD, intensive BP control reduces the risk for adverse cardiovascular outcomes and mortality in the CKD population.
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              Long-term survival of children with end-stage renal disease.

              Allen S. Craig, Michael P. McDonald, (2004)
              Although renal-replacement therapy for children with end-stage renal disease has been used for several decades, data on patients' long-term survival are sparse. We examined the long-term survival of all children and adolescents who were under 20 years of age when renal-replacement therapy commenced (study period, April 1963 through March 2002), using data from the Australia and New Zealand Dialysis and Transplant Registry. Survival was analyzed with the use of Kaplan-Meier methods and age-standardized mortality rates. Risk factors for death were analyzed with the use of Cox regression analysis with time-dependent covariates. A total of 1634 children and adolescents were followed for a median of 9.7 years. The long-term survival rate among children requiring renal-replacement therapy was 79 percent at 10 years and 66 percent at 20 years. Mortality rates were 30 times as high as for children without end-stage renal disease. Risk factors for death were a young age at the time renal-replacement therapy was initiated (especially for children under 1 year of age, among whom the risk was four times as high as for children 15 to 19 years of age) and treatment with dialysis (which was associated with a risk more than four times as high as for renal transplantation). Overall, a trend toward improved survival was observed over the four decades of the study. Despite improvement in long-term survival, mortality rates among children requiring renal-replacement therapy remain substantially higher than those among children without end-stage renal disease. Increasing the proportion of children treated with renal transplantation rather than with dialysis can improve survival further. Copyright 2004 Massachusetts Medical Society
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                Author and article information

                Contributors
                Ebba Bergdahl:
                ORCID: https://orcid.org/0000-0002-4649-8401
                bergdahl.ebba@gmail.com
                Journal
                Journal ID (nlm-ta): Acta Paediatr
                Journal ID (iso-abbrev): Acta Paediatr
                Journal ID (doi): 10.1111/(ISSN)1651-2227
                Journal ID (publisher-id): APA
                Title: Acta Paediatrica (Oslo, Norway : 1992)
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0803-5253
                ISSN (Electronic): 1651-2227
                Publication date (Electronic): 12 January 2023
                Publication date (Print): March 2023
                Volume: 112
                Issue: 3 ( doiID: 10.1111/apa.v112.3 )
                Pages: 557-568
                Affiliations
                [ 1 ] Pediatric Heart Center, the Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
                [ 2 ] Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
                [ 3 ] Department of Pediatrics, the Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
                [ 4 ] Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
                Author notes
                [*] [* ] Correspondence

                Ebba Bergdahl, Pediatric Heart Center, the Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.

                Email: bergdahl.ebba@ 123456gmail.com

                Author information
                https://orcid.org/0000-0002-4649-8401
                https://orcid.org/0000-0001-8269-4488
                Article
                Publisher ID: APA16646 Other ID: SPAE-2022-0998.R1
                DOI: 10.1111/apa.16646
                PMC ID: 10107828
                PubMed ID: 36567640
                SO-VID: 3b9a10ac-2d55-4884-b79e-3bd49f94bea0
                Copyright © © 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date revision received : 16 December 2022
                Date received : 25 November 2022
                Date accepted : 22 December 2022
                Page count
                Figures: 2, Tables: 6, Pages: 12, Words: 5928
                Funding
                Funded by: Swedish state, ALF‐ agreement
                Award ID: ALFGBG‐432071, ALFGBG770541, ALFGBG‐774901, ALFGBG
                Categories
                Subject: Original Article
                Subject: Original Articles & Brief Reports
                Subject: Urology
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.7 mode:remove_FC converted:17.04.2023

                ScienceOpen disciplines: Pediatrics
                Keywords: longitudinal follow‐up,paediatric kidney transplants,vascular ultrasound
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: longitudinal follow‐up, paediatric kidney transplants, vascular ultrasound

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