CARDIOVASCULAR RISK FACTORS ASSESSMENT IN CHILDREN OF CHRONIC KIDNEY DISEASE

Farhana Yasmin*, Shireen Afroz, Tahmina Ferdous, Umme Tanjila and Sukriti Baroi

ABSTRACT

Background: Patients with Chronic Kidney Disease (CKD) are at significantly increased risk for both morbidity and mortality from cardiovascular disease (CVD). The risk factors thought to be responsible for accelerated CVD in children with CKD are traditional risk factors e.g. hypertension, obesity, sedentary lifestyle and non-traditional risk factors e.g. uremia, anemia, hypocalcemia, hyperphosphatemia, hyperparathyroidism. Determining the spectrum of cardiovascular risk factors in these patients can help in reduction of morbidity and mortality from CKD. Material and Methods: This cross-sectional study was held on department of Pediatric Nephrology, Dhaka Shishu Hospital, Dhaka, during July 2018 to December 2018 (Six months). A total of thirty-six children with chronic kidney disease with creatinine clearance <60ml/min/1.73 m2 and age ranged from 2 to 16 years on supportive treatment and hemodialysis were included. In control group equal number of age and sex matched healthy children without any preexisting renal or cardiovascular diseases were included. Both study group and control group were assessed for cardiovascular findings by echocardiography and study group also assessed for cardiovascular risk factors. Results: The mean age was 9.09±3.01 years (mean±SD) in case group and 7.85±3.69 years (mean±SD) in control group. Regarding sex, 22 patients (61.1%) in the case group were male and 14 (38.9%) were female. In this study, in CKD patients significant (p<0.001) difference was observed in following cardiac parameters, left ventricular end diastolic diameter (LVEDD) (38.34 vs 34.52), left ventricular end systolic diameter LVESD (26.64 vs 20.75), interventricular septal thickness (IVS) (9.34 vs 7.27), left ventricular posterior wall thickness (LVPWT) (8.36 vs 7.46), ejection fraction (EF) (56.68% vs 70.36%), fractional shortening (FS) (31.88% vs 38.30%) and peak early diastole velocity/peak atrial filling velocity (E/A ratio) (1.15 vs 1.45) when compared to control group. Significantly lower (p=0.01) Hb% and significantly higher phosphate and parathormone was observed in CKD children who had abnormal echocardiographic findings. Conclusion: Hypertension was a prime traditional risk factor for CVD in CKD children. Amongst non-traditional risk factors anemia, hyperphosphatemia, hyperparathyroidism were noteworthy. Adequate control of hypertension, anemia, hyperphosphatemia and hyperparathyroidism could prevent CVD in children with CKD.

Keywords: Chronic kidney disease, Echocardiography, Risk factors, Child.