Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease

Susan L. Furth, Alison G. Abraham, Judith Jerry-Fluker, George J. Schwartz, Mark Benfield, Frederick Kaskel, Craig Wong, Robert H. Mak, Marva Moxey-Mims, Bradley A. Warady

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

Summary Background and objectives: Metabolic abnormalities and cardiovascular disease (CVD) risk factors have rarely been systematically assessed in children with chronic kidney disease (CKD). We examined the prevalence of various CKD sequelae across the GFR spectrum. Design, setting, participants, & measurements: Data were used from 586 children participating in the Chronic Kidney Disease in Children (CKiD) study (United States and Canada) with GFR measured by iohexol plasma disappearance. Laboratory values and CVD risk factors were compared across GFR categories and with an age-, gender-, and race-matched community sample. Results: CKiD participants were 62% male, 66% Caucasian, 23% African American, and 15% Hispanic with a median age of 11 years and a median GFR of 44 ml/min per 1.73 m2. Compared with those with a GFR≥50 ml/min per 1.73 m2, having a GFR<30 ml/min per 1.73 m2 was associated with a three-fold higher risk of acidosis and growth failure and a four-to five-fold higher risk of anemia and elevated potassium and phosphate. Median GFR change was-4.3 ml/min per 1.73 m2 and-1.5 ml/min per 1.73 m2 per year in children with glomerular and nonglomerular diagnoses, respectively. Despite medication and access to nephrology care, uncontrolled systolic hypertension was present in 14%, and 16% had left ventricular hypertrophy. Children with CKD frequently were also shorter and had lower birth weight, on average, compared with norms. Conclusions: Growth failure, metabolic abnormalities, and CVD risk factors are present at GFR>50 ml/min per 1.73 m2 in children with CKD and, despite therapy, increase in prevalence two- to four-fold with decreasing GFR.

Original languageEnglish (US)
Pages (from-to)2132-2140
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number9
DOIs
StatePublished - Jan 1 2011

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Furth, S. L., Abraham, A. G., Jerry-Fluker, J., Schwartz, G. J., Benfield, M., Kaskel, F., Wong, C., Mak, R. H., Moxey-Mims, M., & Warady, B. A. (2011). Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease. Clinical Journal of the American Society of Nephrology, 6(9), 2132-2140. https://doi.org/10.2215/CJN.07100810