Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure

TY - JOUR

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 -