DOI QR코드

DOI QR Code

Cardiovascular Disease in Pediatric Chronic Kidney Disease

소아 만성 콩팥병에서 나타나는 심혈관계 질환

  • Cho, Min Hyun (Department of Pediatrics, Kyungpook National University School of Medicine)
  • 조민현 (경북대학교 의학전문대학원 소아과학교실)
  • Received : 2014.02.04
  • Accepted : 2014.02.14
  • Published : 2014.04.30

Abstract

Cardiovascular disease (CVD) has been identified as one of the most important factors influencing the long-term prognosis of patients with chronic kidney disease (CKD). However, in pediatric CKD, the clinical importance of CVD tends to be overlooked due to the lack of typical manifestations of CVD in this population. The literature has identified several traditional risk factors of CVD that originate from CKD, including hypertension, diabetes mellitus, dyslipidemia and obesity, in addition to new and non-traditional risk factors including anemia, secondary hyperparathyroidism, oxidative stress and inflammation. In cases of pediatric CKD, cardiovascular disease is usually restricted to subclinical manifestations such as left ventricular hypertrophy, thickening of intimal media on the carotid artery and calcification of the coronary artery. Therefore, risk factors of CVD in pediatric CKD patients should be closely monitored.

만성 콩팥병의 장기 예후를 결정하는 요인 중 심혈관계 합병증의 중요성은 잘 알려져 있다. 그러나 소아 환자의 경우 전형적인 증상 발현이 적어 그 임상적 중요성이 간과되는 경향이 있다. 현재까지 알려진 심혈관계 합병증의 위험인자로는 고혈압, 당뇨병, 이상지질혈증, 비만과 같은 전통적인 위험 인자와 빈혈, 이차성 부갑상선 기능항진증, 산화 스트레스, 염증과 같은 새로운 위험 인자 등이 알려져 있다. 소아 만성 콩팥병의 경우 주로 좌심실 비대나 경동맥 내중막 두께의 증가 및 관상동맥의 석회화 같이 대부분 겉으로 드러나지 않는 증상이므로 위험 인자에 대한 철저한 관리와 지속적인 추적 관찰이 필수적이다.

Keywords

References

  1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32(5 Suppl 3):S112-9. https://doi.org/10.1053/ajkd.1998.v32.pm9820470
  2. Chavers BM, Li S, Collins AJ, Herzog CA. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 2002; 62:648-53. https://doi.org/10.1046/j.1523-1755.2002.00472.x
  3. Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004;15:1307-15. https://doi.org/10.1097/01.ASN.0000123691.46138.E2
  4. Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 2002;141:191-7. https://doi.org/10.1067/mpd.2002.125910
  5. Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, et al. Mortality and causes of death of endstage renal disease in children: a Dutch cohort study. Kidney Int 2002;61:621-9. https://doi.org/10.1046/j.1523-1755.2002.00156.x
  6. U.S. Renal Data System. USRDS 2000 Annual Data Report, 2000. Bethesda: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2000.
  7. U.S. Renal Data System. USRDS 2008 Annual Data Report, 2008. Bethesda: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2008.
  8. Mitsnefes M, Ho PL, McEnery PT. Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAP RTCS). J Am Soc Nephrol 2003;14:2618-22. https://doi.org/10.1097/01.ASN.0000089565.04535.4B
  9. Mitsnefes M, Stablein D. Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Kidney Dis 2005;45:309-15. https://doi.org/10.1053/j.ajkd.2004.11.006
  10. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, et al. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension 2008;52:631-7. https://doi.org/10.1161/HYPERTENSIONAHA.108.110635
  11. Hanevold CD, Ho PL, Talley L, Mitsnefes MM. Obesity and renal transplant outcome: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 2005;115:352-6. https://doi.org/10.1542/peds.2004-0289
  12. Mitsnefes MM, Khoury P, McEnery PT. Body mass index and allograft function in pediatric renal transplantation. Pediatr Nephrol 2002;17:535-9. https://doi.org/10.1007/s00467-002-0863-9
  13. Prokai A, Fekete A, Kis E, Reusz GS, Sallay P, Korner A, et al. Post-transplant diabetes mellitus in children following renal transplantation. Pediatr Transplant 2008;12:643-9. https://doi.org/10.1111/j.1399-3046.2007.00862.x
  14. Lai HL, Kartal J, Mitsnefes M. Hyperinsulinemia in pediatric patients with chronic kidney disease: the role of tumor necrosis factor-alpha. Pediatr Nephrol 2007;22:1751-6. https://doi.org/10.1007/s00467-007-0533-z
  15. Painter P, Krasnoff J, Mathias R. Exercise capacity and physical fitness in pediatric dialysis and kidney transplant patients. Pediatr Nephrol 2007;22:1030-9. https://doi.org/10.1007/s00467-007-0458-6
  16. Weaver DJ, Jr., Kimball TR, Knilans T, Mays W, Knecht SK, Gerdes YM, et al. Decreased maximal aerobic capacity in pediatric chronic kidney disease. J Am Soc Nephrol 2008;19: 624-30. https://doi.org/10.1681/ASN.2007070773
  17. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM. The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int 2002;62:1524-38. https://doi.org/10.1046/j.1523-1755.2002.00600.x
  18. Wilson AC, Mitsnefes MM. Cardiovascular disease in CKD in children: update on risk factors, risk assessment, and management. Am J Kidney Dis 2009;54:345-60. https://doi.org/10.1053/j.ajkd.2009.04.027
  19. Vanholder R, Massy Z, Argiles A, Spasovski G, Verbeke F, Lameire N. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant 2005;20: 1048-56. https://doi.org/10.1093/ndt/gfh813
  20. VanDeVoorde RG, Barletta GM, Chand DH, Dresner IG, Lane J, Leiser J, et al. Blood pressure control in pediatric hemodialysis: the Midwest Pediatric Nephrology Consortium Study. Pediatr Nephrol 2007;22:547-53. https://doi.org/10.1007/s00467-006-0341-x
  21. Ulinski T, Genty J, Viau C, Tillous-Borde I, Deschenes G. Reduction of left ventricular hypertrophy in children undergoing hemodialysis. Pediatr Nephrol 2006;21:1171-8. https://doi.org/10.1007/s00467-006-0122-6
  22. Fadrowski JJ, Pierce CB, Cole SR, Moxey-Mims M, Warady BA, Furth SL. Hemoglobin decline in children with chronic kidney disease: baseline results from the chronic kidney disease in children prospective cohort study. Clin J Am Soc Nephrol 2008;3:457-62. https://doi.org/10.2215/CJN.03020707
  23. Jono S, Nishizawa Y, Shioi A, Morii H. 1,25-Dihydroxyvitamin D3 increases in vitro vascular calcification by modulating secretion of endogenous parathyroid hormone-related peptide. Circulation 1998;98:1302-6. https://doi.org/10.1161/01.CIR.98.13.1302
  24. Mitsnefes MM. Cardiovascular morbidity and mortality in children with chronic kidney disease in North America: lessons from the USRDS and NAPRTCS databases. Perit Dial Int 2005; 25(Suppl 3):S120-2.
  25. Gruppen MP, Groothoff JW, Prins M, van der Wouw P, Offringa M, Bos WJ, et al. Cardiac disease in young adult patients with end-stage renal disease since childhood: a Dutch cohort study. Kidney Int 2003;63:1058-65. https://doi.org/10.1046/j.1523-1755.2003.00814.x
  26. Matteucci MC, Wuhl E, Picca S, Mastrostefano A, Rinelli G, Romano C, et al. Left ventricular geometry in children with mild to moderate chronic renal insufficiency. J Am Soc Nephrol 2006;17:218-26. https://doi.org/10.1681/ASN.2006080918
  27. Kavey RE, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2006;114:2710-38. https://doi.org/10.1161/CIRCULATIONAHA.106.179568
  28. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555-76. https://doi.org/10.1542/peds.114.2.S2.555
  29. Kasiske B. Managing dyslipidemias in chronic kidney disease. Nephrol News Issues 2003;17:81-3, 93.
  30. Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122(1):198-208. https://doi.org/10.1542/peds.2008-1349
  31. de Ferranti S, Ludwig DS. Storm over statins--the contro-versy surrounding pharmacologic treatment of children. N Engl J Med 2008;359:1309-12. https://doi.org/10.1056/NEJMp0805953
  32. Nelson RG, Tuttle KR. The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD. Blood Purif 2007;25:112-4. https://doi.org/10.1159/000096407
  33. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006;47(5 Suppl 3):S11-145. https://doi.org/10.1053/j.ajkd.2006.03.010
  34. Delucchi A, Dinamarca H, Gainza H, Whitttle C, Torrealba I, Iniguez G. Carotid intima-media thickness as a cardiovascular risk marker in pediatric end-stage renal disease patients on dialysis and in renal transplantation. Transplant Proc 2008; 40:3244-6. https://doi.org/10.1016/j.transproceed.2008.03.126