Assessment of risk factors for cardiovasuclar disease in pediatric renal transplant patients
Douglas M. Silverstein,
Miranda Mitchell, Pamela LeBlanc,
J. Philip Boudreaux,
Douglas M. Silverstein
Department of Pediatrics, Division of Nephrology, Louisiana State University Health Sciences Center
Division of Nephrology, Children’s Hospital, New Orleans
Search for more papers by this authorPamela LeBlanc
Division of Nephrology, Children’s Hospital, New Orleans
Search for more papers by this authorJ. Philip Boudreaux
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
Search for more papers by this authorDouglas M. Silverstein,
Miranda Mitchell, Pamela LeBlanc,
J. Philip Boudreaux,
Douglas M. Silverstein
Department of Pediatrics, Division of Nephrology, Louisiana State University Health Sciences Center
Division of Nephrology, Children’s Hospital, New Orleans
Search for more papers by this authorPamela LeBlanc
Division of Nephrology, Children’s Hospital, New Orleans
Search for more papers by this authorJ. Philip Boudreaux
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
Search for more papers by this authorDouglas M. Silverstein, Children’s Hospital, Division of Nephrology, Research and Education Building, Suite 4241, 200 Henry Clay Avenue, New Orleans, LA 70118, USATel.: (504) 896-9202Fax: (504) 896-9240E-mail: [email protected]
Abstract
Abstract: Pediatric renal TP recipients are at risk for CVD. We performed a cross-sectional study of the prevalence of RF for CVD in 45 long-term pediatric renal TP patients. The time since TP was 42 months. The GFR was 87.8 ± 3.4 mL/min/1.73m2; 25/45 (56%) had Stage 2–4 CKD. A total of 33% had elevated SBP and 24% had high DBP; 57% had elevated SBP or DBP. A total of 20% had elevated serum CHOL levels, while 45% had high serum TG levels. A total of 42% had high HCY levels and 50% had low HCT levels. The vast majority (66.7%) had at least two RF for CVD. A total of 18.2% had abnormal post-TP echocardiography results. There was a negative correlation between GFR and SBP, DBP, serum CHOL, HCY, and BMI. There was a positive correlation between GFR and HCT. Serum CHOL was significantly lower and SBP and DBP trended lower in patients on a SF immunosuppression regimen. Similarly, SBP and DBP trended higher and CHOL was significantly higher in patients receiving SRL vs. mycophenolate mofetil. We conclude that the majority of pediatric renal TP patients exhibit multiple CVD RF.
References
- 1 Mistnefes MM. Pediatric end-stage renal disease: Heart as a target. J Pediatr 2002: 141: 162–164.
- 2 Silverstein DM, Palmer J, Polinsky MS, Braas C, Conley SB, Baluarte HJ. Risk factors for hyperlipidemia in long-term pediatric renal transplant recipients. Pediatr Nephrol 2000: 14: 105–110.
- 3 Mitsnefes MM, Khoury P, McEnery PT. Body mass index and allograft function in pediatric renal transplantation. Pediatr Nephrol 2002: 7: 535–539.
- 4 Mitsnefes MM, Omoloja A, McEnery PT. Short-term pediatric renal transplant survival: Blood pressure and allograft function. Pediatr Transplant 2001: 5: 160–165.
- 5 Greenspan LC, Gitelman SE, Leung MA, Glidden DV, Mathias RS. Increased incidence of post-transplant diabetes mellitus in children: A case-control analysis. Pediatr Nephrol 2002: 17: 1–5.
- 6 Dharnidharka VR, Harmon WE. Management of pediatric postrenal transplantation infections. Semin Nephrol 2001: 21: 521–531.
- 7 Melter M, Briscoe DM. Challenges after pediatric transplantation. Semin Nephrol 2000: 20: 199–208.
- 8 Matsuda-Abedini M, Portale AA, Shah A, Neuhaus J, McEnhill M, Mathias RS. Persistent secondary hyperparathyroidism after renal transplantation in children. Pediatr Nephrol 2006: 21: 413–418.
- 9 Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998: 9: s16–s23.
- 10 Parekh RS, Carrol CE, Wolfe RA, Port FK. Cardiovascular death in children and young adults with end-stage kidney disease. J Pediatr 2002: 141: 191–197.
- 11 Matteucci MC, Giordano U, Calzolari A, Turchetta A, Santilli A, Rizzoni G. Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients. Kidney Int 1999: 56: 1566–1570.
- 12 Mann JFE, Gerstein HC, Dulau-florea I, Lonn E. Cardiovascular risk in patients with mild renal insufficiency. Kidney Int 2003: 63(S84): S192–196.
- 13 Baluarte HJ, Gruskin AB, Ingelfinger JR, Stablein D, Tejani A. Analysis of hypertension in children post renal transplantation–a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Nephrol 1994: 8: 570–573.
- 14 Ibels LS, Alfrey AC, Weil R III. Hyperlipidemia in adults, pediatric, and diabetic renal transplant recipients. Am J Med 1978: 64: 634–642.
- 15 Saldanha LF, Hurst KS, Amend WJ Jr, et al. Hyperlipidemia after renal transplantation in children. Am J Dis Child 1976: 130: 951S–953S.
- 16 Sharma AK, Myers TA, Hunninghake DB, Matas AJ, Kashtan CE. Hyperlipidemia in long-term survivors of pediatric renal transplantation. Clin Transplant 1994: 8: 252–257.
- 17 Aldamiz-Echevarria L, Sanjuro P, Vallo A, et al. Hyperhomocysteinemia in children with renal transplants. Pediatr Nephrol 2002: 17: 718–723.
- 18 Perfumo F, Canepa A, Divino-Filho JC, et al. Muscle and plasma amino acids and nutritional status in kidney transplanted children. Nephrol Dial Transplant 1994: 9: 1778–1785.
- 19 Yorgin PD, Belson A, Sanchez J, et al. Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult renal transplant recipients. Am J Kidney Dis 2002: 40: 1306–1318.
- 20 Johnstone LM, Jones CL, Grigg LE, Wilkjinson JL, Walker RG, Powell HR. Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 1996: 50: 998–1006.
- 21 Sarwal MM, Vidhun JR, Alexander SR, et al. Continued superior outcomes with modification and lengthened follow-up of a steroid-avoidance pilot with extended daclizumab induction in pediatric renal transplantation. Transplantation 2003: 76: 1331–1339.
- 22 Silverstein DM, Aviles DH, Leblanc PM, Jung FF, Vehaskari VM. Results of one year follow-up of steroid-free immunosuppression in pediatric renal transplant patients. Pediatr Transplant 2005: 9: 162–169.
- 23 National high blood pressure education program working group on high blood pressure in children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004: 114(2 Suppl. 4th Report): 555.
- 24 K/DOQI. Clinical Practice Guidelines for chronic kidney diseases: Evaluation, classification, and stratification. Am J Kidney Dis 2002: 39(Suppl. 1): S17–S21.
- 25 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2004: 27: S5–S10.
- 26 Wuhl E, Hadtstein C, Mehls O, Schaefer F, Escape trial group. Home, clinic, and ambulatory blood pressure monitoring in children with chronic renal failure. Pediatr Res 2004: 55: 492–497.
- 27 Querfeld U. Disturbances of lipid metabolism in children with chronic renal failure. Pediatr Nephrol 1993: 7: 749–757.
- 28 Poyrazoglu HM, Dusunsel R, Narin F, et al. Homocysteine and left ventricular hypertrophy in children with chronic renal failure. Pediatr Nephrol 2004: 19: 193–198.
- 29 Eschbach JW, Funk DD, Adamson J. The anemia of chronic renal failure: Pathophysiology and the effects of recombinant erythropoietin. Kidney Int 1989: 35: 134–148.
- 30 Mak RH, Cheung W. Energy homeostasis and cachexia in chronic kidney disease. Pediatr Nephrol 2006: 21: 1807–1814.
- 31 Mak RH, Haycock G, Chantler C. Glucose intolerance in children with chronic renal failure. Kidney Int 1993: 15 (Suppl): S22–S26.
- 32 Höcker B, John U, Plank C, et al. Successful withdrawal of steroids in pediatric renal transplant recipients receiving cyclosporine A and mycophenolate mofetil treatment: Results after four years. Transplantation 2004: 78: 228–234.
- 33 Ribes D, Kamar N, Esposito L, Rostaing L. Combined use of tacrolimus and sirolimus in de novo renal transplant patients: Current data. Transpl Proc 2005: 37: 2813–2816.
- 34 Gonwa T, Mendez R, Vang HC, Weisntein S, Jensik S, Steinberg S. Prograf study group: Randomized trial of tacrolimus in combination with sirolimus or mycophenolate mofetil in kidney transplantation: results at 6 months. Transplantation 2003: 75: 1213–1220.
- 35 Almeida M, Martins LS, Dias L, et al. Conversion to sirolimus in a population of kidney and kidney-pancreas transplant recipients. Transpl Proc 2005: 37: 2777–2780.
- 36 Morrisett JD, Abdel-Fattah G, Hoogeveen R, et al. Effects of sirolimus on plasma lipids, lipoprotein levels, and fatty acid metabolism in renal transplant patients. J Lipid Res 2002: 43: 1170–1180.
- 37 Romero F, Rodríguez-Iturbe B, Pons H, et al. Mycophenolate mofetil treatment reduces cholesterol-induced atherosclerosis in the rabbit. Atherosclerosis 2002: 152: 127–133.
- 38 Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 2002: 39: 695–701.
- 39 Sorof JM. Ambulatory blood pressure monitoring in pediatric end-stage renal disease: Chronic dialysis and transplantation. Blood Press Monit 1999: 4: 171–174.
Citing Literature
