Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure
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Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. / Oh, Jun; Wunsch, Rainer; Turzer, Martin; Bahner, Malte; Raggi, Paolo; Querfeld, Uwe; Mehls, Otto; Schaefer, Franz.
in: CIRCULATION, Jahrgang 106, Nr. 1, 02.07.2002, S. 100-5.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure
AU - Oh, Jun
AU - Wunsch, Rainer
AU - Turzer, Martin
AU - Bahner, Malte
AU - Raggi, Paolo
AU - Querfeld, Uwe
AU - Mehls, Otto
AU - Schaefer, Franz
PY - 2002/7/2
Y1 - 2002/7/2
N2 - BACKGROUND: Cardiovascular mortality is excessive in young adults with end-stage renal disease (ESRD). The factors contributing to ESRD-related vascular disease are incompletely understood. Young adults with childhood-onset chronic renal failure (CRF) are uniquely suited for risk factor assessment because of their long-term exposure at an age when vascular pathology in the general population is still minimal.METHODS AND RESULTS: We used novel noninvasive technologies to screen for coronary and carotid artery disease in 39 patients with ESRD aged 19 to 39 years with childhood-onset CRF presently treated by dialysis or renal transplantation. Coronary artery calcification burden was assessed by CT scan with ECG gating and the intima-media thickness (IMT) of the carotid arteries by high-resolution ultrasound. Coronary artery calcifications were present in 92% of patients; calcium scores exceeded the 95th age- and sex-specific percentiles >10-fold on average. Carotid IMT was significantly increased compared with matched control subjects. Both coronary calcium scores and IMT were associated with cumulative dialysis and ESRD time and the cumulative serum calcium-phosphate product. Coronary calcium scores were strongly correlated with C-reactive protein and Chlamydia pneumoniae seropositivity, time-averaged mean serum parathyroid hormone, and plasma homocysteine. C-reactive protein and parathyroid hormone independently predicted coronary calcium accumulation. Smoking, obesity, and HbA1c were correlated with IMT in the control subjects but not in the patients.CONCLUSIONS: Young adults with childhood-onset CRF have a high prevalence of arteriopathy associated with indicators of microinflammation, hyperparathyroidism, calcium-phosphate overload, and hyperhomocysteinemia but not traditional atherogenic risk factors. These risk factors persist even after successful renal transplantation.
AB - BACKGROUND: Cardiovascular mortality is excessive in young adults with end-stage renal disease (ESRD). The factors contributing to ESRD-related vascular disease are incompletely understood. Young adults with childhood-onset chronic renal failure (CRF) are uniquely suited for risk factor assessment because of their long-term exposure at an age when vascular pathology in the general population is still minimal.METHODS AND RESULTS: We used novel noninvasive technologies to screen for coronary and carotid artery disease in 39 patients with ESRD aged 19 to 39 years with childhood-onset CRF presently treated by dialysis or renal transplantation. Coronary artery calcification burden was assessed by CT scan with ECG gating and the intima-media thickness (IMT) of the carotid arteries by high-resolution ultrasound. Coronary artery calcifications were present in 92% of patients; calcium scores exceeded the 95th age- and sex-specific percentiles >10-fold on average. Carotid IMT was significantly increased compared with matched control subjects. Both coronary calcium scores and IMT were associated with cumulative dialysis and ESRD time and the cumulative serum calcium-phosphate product. Coronary calcium scores were strongly correlated with C-reactive protein and Chlamydia pneumoniae seropositivity, time-averaged mean serum parathyroid hormone, and plasma homocysteine. C-reactive protein and parathyroid hormone independently predicted coronary calcium accumulation. Smoking, obesity, and HbA1c were correlated with IMT in the control subjects but not in the patients.CONCLUSIONS: Young adults with childhood-onset CRF have a high prevalence of arteriopathy associated with indicators of microinflammation, hyperparathyroidism, calcium-phosphate overload, and hyperhomocysteinemia but not traditional atherogenic risk factors. These risk factors persist even after successful renal transplantation.
KW - Adolescent
KW - Adult
KW - Age of Onset
KW - Calcinosis/diagnostic imaging
KW - Cardiomyopathies/diagnostic imaging
KW - Carotid Stenosis/diagnostic imaging
KW - Child
KW - Coronary Angiography
KW - Female
KW - Humans
KW - Kidney Failure, Chronic/diagnosis
KW - Male
KW - Risk Assessment
KW - Survival Rate
KW - Tomography, X-Ray Computed
KW - Ultrasonography
U2 - 10.1161/01.cir.0000020222.63035.c0
DO - 10.1161/01.cir.0000020222.63035.c0
M3 - SCORING: Journal article
C2 - 12093777
VL - 106
SP - 100
EP - 105
JO - CIRCULATION
JF - CIRCULATION
SN - 0009-7322
IS - 1
ER -