Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease—impact of calcium and vitamin D therapy

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 7; pp. 1906 - 1914
• Main Authors: Briese, Sonia, Wiesner, Sandra, Will, Joachim C., Lembcke, Alexander, Opgen-Rhein, Bernd, Nissel, Richard, Wernecke, Klaus-Dieter, Andreae, Judit, Haffner, Dieter, Querfeld, Uwe
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2006; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Age of Onset; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arteries - pathology; atherosclerosis; Biological and medical sciences; calcifications; calcium; Calcium - therapeutic use; children; Echocardiography; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Female; Heart Diseases - complications; Heart Diseases - therapy; Humans; Intensive care medicine; Kidney Failure, Chronic - complications; Male; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Plethysmography; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tunica Intima - pathology; Tunica Media - pathology; Vascular Diseases - complications; Vascular Diseases - therapy; vitamin D; Vitamin D - therapeutic use; Human; Kidney disease; Urinary system disease; Calcium; Hemodialysis; calcifications; Cardiovascular disease; Terminal stage; end-stage renal disease; Inorganic element; Vascular disease; Arterial disease; Arteriopathy; Extrarenal dialysis; Treatment; Vitamin D; children; Young adult; Atherosclerosis; Renal failure; Calcification; Child
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfl098

Background. Studies in patients with childhood-onset end-stage renal disease (ESRD) provide a diagnostic window to the evolution of cardiovascular disease (CVD) in this population. Hyperphosphataemia and renal osteodystrophy are particularly difficult to treat in paediatric patients, but there is only limited information regarding the effect of calcium-containing phosphate binders and vitamin D preparations on the development of CVD in the young. Methods. We studied 40 adult patients (mean age 23.6 years) who developed ESRD at the age of 11.5± 4 years and 40 matched healthy control subjects. Nine patients were on dialysis and 31 had a functioning kidney transplant. Measurements included intima-media thickness (IMT) of the common carotid artery, electron beam computed tomography (EBCT) for the detection of coronary artery calcifications (CAC), echocardiography and post-ischaemic arterial blood flow by venous occlusion plethysmography. Patient characteristics, atherosclerotic risk factors and a complete account of prescribed medications were analysed for correlations with arterial and cardiac changes. Results. The IMT was not significantly different in patients and controls; four patients (10%) had coronary calcifications on EBCT. Twenty-five patients (62.5%) had left ventricular hypertrophy. Patients had a 40% reduction of post-ischaemic arterial flow. Morphological alterations of the heart and arteries were significantly correlated with the duration of ESRD and dialysis time, and with the cumulative intake of calcium-containing phosphate binders and active vitamin D preparations. Functional changes (vascular reactivity) were correlated with duration of ESRD and non-traditional risk factors. Conclusions. Young adults with ESRD since childhood have systemic CVD characterized by a decrease in arterial elasticity, the occurrence of CAC and changes in left ventricular morphology. Treatment with calcium-containing phosphate binders and active vitamin D preparations is independently associated in a dose-dependent manner with surrogate markers for CVD.