Evaluation of arterial stiffness in patients with chronic kidney disease of childhood

Chronic kidney disease (CKD) can be defined as a chronic and progressive deterioration in the regulation of fluid solute balance and metabolic-endocrine functions of the kidney as a result of a decrease in glomerular filtration rate. Cardiovascular disease, which is one of the most important causes of morbidity and mortality in CKD, and arterial stiffness, which is one of the best markers to determine cardiovascular disease at an early stage, should be evaluated. In our study, it was aimed to determine the risk of arterial stiffness using oscillometric method in patients with chronic kidney disease in the pediatric age group, and to investigate the effects of CKD duration and stage and risk factors such as parathormon, calcium, phosphorus cholesterol, and weight that increase the risk of arterial stiffness. In this study, 33 patients who were diagnosed with CKD in the Pediatric Nephrology Outpatient Clinic of Gaziantep University which 17 patients of ESRD who underwent peritoneal dialysis, 9 patients who underwent hemodialysis and 7 patients GFR between 15-60 ml/min/1.73 m2 and had diagnosis of stage 3-4 CKD were included in the study. 34 healthy children were selected by considering age and body mass index, who applied to Gaziantep University Faculty of Medicine Pediatric Health and Diseases outpatient clinic, which did not have a known serious or chronic disease and were not using medication at the time of the study. Laboratory results of the patient group were obtained from the archive. Pulse wave velocity analysis of all cases was performed with an automatic oscillometric device (Mobil-O-Graph, IEM). On the same day, 2D echocardiography and 3D/4D strain echocardiography imaging were performed by same physician with Vivid E9 XD Clear echocardiography device. Processing of images was performed with EchoPAC software. While there was no significant difference between the patient and control groups in terms of mean age (12.45±3.02 vs 13.21±2.45) and gender ratios (F/M=17/17 vs F/M=18/15) (p=0.268 and p=0.710, respectively), there was a significant difference between, BMI levels (16.94±3.14 vs 20.82±3.98, p<0.001), weight SDS [-2.24 (-7.21-1.29) vs-0.24 (-2.74-2.89), p<0.001] and height SDS [-2.57 (- 6.72-2.07) vs-0.16 (-2.12-2.48), p<0.001]. Considering the blood pressure and heart rate values; The systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure values (126.78±20.78, 84.21±19.26 and 103.48±18.13) in the patient group were higher than the control group (112.58±10.18, 66.88±6.36 and 87.91±6.54). And the differences were found to be statistically significant (p=0.001, p<0.001, p<0.001, respectively). Among the values measured by the oscillometric method of the groups, the PWV, peripheral resistance and augmentation index values [5.02±0.69, 36.15±12.83 and 1687.70±240.57] in the patient group, compared to the control group [4.56±0.32, 29.88±9.03 and 1538.87±176.64] were found to be significantly high (p=0.001, p=0.025 and p=0.005, respectively). It was determined that there were positive, statistically significant, very high/excellently strong correlations between PWV and SBP, DBP, MAP values in the patient group (r=0.984, p<0.001, r=-0.674, p<0.001 ve r=-0.897, p<0.001, respectively).It was determined that there were positive, moderately strong and statistically significant correlations between the augmentation index and DBP and MAP values (r=0.422, p=0.014 and r=0.347, p=0.048, respectively). In echocardiography parameters, ED MassI (2B) and ES MassI (2D) values were 110.0 (72.0-44.0) and 101.0 (76.0-158.0, respectively) in the patient group, compared to the control group [79.0 (53.0-112.0) and 83.0 (53.0-118.0, respectively))] were found to be statistically significantly higher (p<0.001 and p<0.001, respectively). Also, the MV E Vel (2B) and MV A Vel (2B) values in the patient group [1.1 (0.7-1.45) and 0.69 (0.47-1.01), respectively), compared to the control group [1.0 (0.46-1.5) and 0.52 (0.29-, respectively)]. 0.82)] was found to be statistically significantly higher (p=0.010 and p=0.001, respectively). In strain echocardiography measurements, LS and AS values were found to be lower in the patientgroup [-10.0 (-20.0- -1.0) and-16.0 (-27.0- 0.0)] than in the control group [-7.0 (-14.0- -4.0) and-12.5 (-25.0-) 6.0)], and the differences were statistically significant (p=0.007 and p=0.019, respectively). However, no statistically significant difference was found in the RS and CS values. In arterial stiffness parameters, pulse wave velocity, peripheral resistance and augmentation index values in the patient group were found to be statistically significantly higher than in the control group. Among the echocardiographic measurements evaluating systolic and diastolic functions, there was a statistically significant difference between the patient and control groups in the values of MV A Vel and MV E Vel, which indicate that diastolic functions began to deteriorate. There was no statistically significant difference between the patient and control groups in echocardiographic measurements evaluating systolic and diastolic functions. Our study revealed that arterial stiffness can occur in children with chronic kidney disease, and that oscillometric devices are easy to use and applicable in measuring arterial stiffness, and that this method can be used in clinical follow-up. Another result we found is that LV mass, mass index increased, LS and AS values were significantly higher, but global strain was also not affected, and it is thought that this may be due to the fact that ejection fraction and systolic functions are not yet impaired. Keywords: Chronic Kidney Disease, Arterial Stiffness, Pulse Wave Velocity, Strain Echocardiography