Adipokines as predictive factor of cardiac function in pediatric patients with chronic kidney disease.

Background: Adipokines are associated with cardiovascular disease; in chronic kidney disease (CKD) patients adipokines could be useful prognostic factors. Objectives: To explore whether leptin and adiponectin in kidney replacement therapy (KRT) children could have a role on their cardiac function, in the long-term. Design: Prospective cohort study was performed with pediatric KRT patients, aged 8 to 17 years who were undergoing hemodialysis or peritoneal dialysis. At enrollment, lipid profile, adipokines (leptin, leptin receptor, free leptin, and adiponectin), anthropometric measurements and cardiological evaluation were determined. At two-year follow-up, a new cardiological evaluation was performed. Statistical analysis: Quantitative data are presented as median and interquartile range (IQR). Mann-Whitney U test and Chi-squared were used for the between-group comparison. Multivariate analyzes were performed to determine the association of adipokines levels with ventricular ejection fraction (LEVF). Results: We included 56 patients, with a median age of 12.5 years. In the first cardiological evaluation, median LVEF was 70.0% (IQR 61%, 76%), 20 patients (35.7%) had some cardiovascular condition, and 10 (17.8%) altered LVEF. At 24-month follow-up, the median LVEF was 70.5% (IQR 65.1%, 77%), while the delta-LVEF values was 3% (IQR -6.5%, 7%). Delta-LVEF were correlated with baseline adipokines serum levels, and the only positive correlation found was with free leptin (r=0.303, p=0.025). In multivariate analysis, levels of free leptin (Coef. 0.12, p<0.036) and leptin (coef. 1.72, p=0.049), as well as baseline LVEF (Coef. -0.65, p<0.001) were associated with delta-LVEF. Conclusions: Free leptin, leptin and LVEF at the beginning of follow-up were associated with the LVEF decrease at the 24-month follow-up in KRT children.

Leptin receptor and prolactin in pubertal disorders and chronic kidney disease.

BACKGROUND: Knowledge of chronic kidney disease (CKD) with pubertal disorders (PD) in adolescent boys is limited as few studies have explored this disorder. This study aimed to identify the usefulness of assessing hormonal parameters in male adolescents with CKD and their correlation with PD in a 12-month follow-up period. METHODS: A prospective cohort study was conducted among male adolescents with CKD (stages IV and V). Data regarding the age at puberty onset were collected from the patients' clinical records and through interview. The patients were followed up for 12 months during their pubertal development. At the beginning, routine hormonal profile tests were performed to examine the patients' thyroid profile, prolactin levels, luteinizing hormone, follicle-stimulating hormone, testosterone, leptin, and receptor leptin. The hormonal profiles of patients with and without PD were compared. Comparisons between the groups were performed using the Student t-test and Fisher's exact tests. Logistic regression analysis was also performed. RESULTS: Data of 64 patients (26/64 with PD) were analyzed. The median age was 15 years and the median time for CKD evolution was 11 months. No differences between groups were noted in the general or biochemical characteristics of the patients. The hormonal parameters, prolactin levels were higher and the free leptin and free thyroxine levels were lower in patients with PD. Leptin receptor levels of >0.90 ng/mL (risk ratio [RR], 8.6; P = 0.004) and hyperprolactinemia (RR, 21.3; P = 0.049) were the risk factors for PD. CONCLUSIONS: Leptin receptor levels of >0.90 ng/mL and hyperprolactinemia are associated with the development of PD in male adolescents with CKD.

The leptin/adiponectin ratio as prognostic marker for dyslipidemia during 1 year of follow-up in pediatric patients receiving kidney replacement therapy.

Introduction: Background: leptin and adiponectin are associated with cardiovascular disease in chronic kidney disease (CKD) patients and could be useful prognostic factors. Objectives. to explore the usefulness of the leptin/adiponectin ratio (LAR) to predict the presence or worsening of dyslipidemia during 1 year of follow-up in children receiving kidney replacement therapy (KRT). Material and methods: a prospective cohort study was performed. Pediatric KRT patients aged between 8 and 17 years who were undergoing hemodialysis or peritoneal dialysis were included. At enrollment, the lipid profile, adiponectin and leptin levels, and somatometric measurements, including body fat percentage, were determined. At the one-year follow-up, the lipid profile was reassessed. Results: of the 70 patients included, the median age was 13 years, and there was no sex predominance (52.8 % males). At the end of follow-up, the patients were divided into three groups: those without dyslipidemia (WOD), those who developed or experienced worsening of their dyslipidemia (DWD) and those with persistent dyslipidemia (PD). A LAR > 0.85 (OR, 16.7) and body fat percentage (OR, 1.46) were associated with an increased risk of PD and DWD at 12 months, independently of urea level, BMI Z-score, benzafibrate treatment, CKD progression time, and replacement treatment. Conclusions: a LAR > 0.85 and fat body percentage at the beginning of follow-up were strongly associated with the presence, persistence or worsening of dyslipidemia at the 12-month follow-up in children with KRT.

Introducción: Antecedentes: la leptina y la adiponectina se asocian con enfermedad cardiovascular en los pacientes con enfermedad renal crónica (ERC) y podrían ser factores pronósticos útiles. Objetivos: explorar la utilidad del cociente leptina/adiponectina (LAR) para predecir la presencia o empeoramiento de la dislipidemia durante 1 año de seguimiento en niños que reciben terapia de reemplazo renal (TRR). Material y métodos: se realizó un estudio de cohortes prospectivo. Se incluyeron pacientes pediátricos con TRR de entre 8 y 17 años que estaban en hemodiálisis o diálisis peritoneal. Al inicio del estudio se determinaron el perfil lipídico, los niveles de adiponectina y leptina, y las mediciones somatométricas, incluido el porcentaje de grasa corporal. En el seguimiento de un año, se reevaluó el perfil de lípidos. Resultados: de los 70 pacientes incluidos, la mediana de edad fue de 13 años y no hubo predominio de sexo (52,8 % de varones). Al final del seguimiento, los pacientes se dividieron en tres grupos: aquellos sin dislipidemia (SD), aquellos que desarrollaron o experimentaron un empeoramiento de su dislipidemia (ED) y aquellos con dislipidemia persistente (PD). Un LAR > 0,85 (OR: 16,7) y el porcentaje de grasa corporal (OR: 1,46) se asociaron con un mayor riesgo de ED y PD a los 12 meses, independientemente del nivel de urea, la puntuación Z del IMC, el tratamiento con benzafibrato, el tiempo de progresión de la ERC y el tratamiento de reemplazo. Conclusiones: un LAR > 0,85 y el porcentaje de grasa corporal al inicio del seguimiento se asociaron fuertemente con la presencia, persistencia o empeoramiento de la dislipidemia a los 12 meses de seguimiento en niños con TRR.

[Usefulness of a nutritional strategy on dyslipidemia in pediatric patients with terminal chronic kidney disease]. / Utilidad de una estrategia nutricional sobre la dislipidemia en pacientes pediátricos con enfermedad renal crónica terminal.

Introduction: Background and objective: in chronic kidney disease (CKD) there are several factors that increase the presence of dyslipidemia. The aim of this study was to identify the usefulness of a nutritional intervention, in children with terminal CKD, on dyslipidemia 6 months after intervention start. Materials and methods: a quasi-experiment study (before and after) was performed. End-stage CKD patients on peritoneal dialysis and hemodialysis were included. Each child underwent a determination somatometry, and lipid profile at the beginning and at 6 months of follow-up. A nutritional guide was made with food traffic lights, turning the food that should be consumed in the least amount possible in red. In addition to including life-size food using educational models. To compare the quantitative variables before and after the intervention, the variables were transformed to their logarithm and a paired Student's t-test was applied. Results: a total of 41 patients were analyzed. After the intervention, the parameters in the lipid profile were modified; meanwhile HDL concentrations increased (41.0 mg/dL vs 44.4 mg/dL, p = 0.048), triglyceride concentrations decreased (227.1 mg/dL vs 185.9 mg/dL, p = 0.007), and these changes persist even after excluding patients who were under lipid-lowering treatment (195 mg/dL vs 171.6, p = 0.049). Regarding the state of dyslipidemia, hypertriglyceridemia decreased, without reaching significance (80.5 % vs 62.5 %, p = 0.073). Conclusions: the nutritional intervention improved HDL and triglyceride concentrations 6 months afterwards in children with terminal CKD.

Introducción: Antecedentes y objetivo: en la enfermedad renal crónica (ERC) existen múltiples factores que incrementan la presencia de la dislipidemia. El objetivo fue identificar la utilidad de una intervención nutricional sobre la dislipidemia, en niños con ERC terminal, a los 6 meses del inicio de la intervención. Materiales y métodos: estudio cuasiexperimental (antes y después). Se incluyeron pacientes con ERC terminal en diálisis peritoneal y hemodiálisis. A cada niño se le realizaron una somatometría y un perfil de lípidos al inicio y a los 6 meses de seguimiento. Se realizó un manual de alimentación con semaforización de los alimentos, poniendo de color rojo los alimentos que se deben consumir en la menor cantidad posible, además de incluir alimentos a tamaño real utilizando modelos educativos. Para comparar las variables cuantitativas antes y después de la intervención se transformaron las variables a su logaritmo y se aplicó la "t" de Student pareada. Resultados: se analizaron 41 pacientes. Posteriormente a la intervención se modificaron los parámetros del perfil lipídico; las concentraciones de HDL se incrementaron (41,0 mg/dL vs. 44,4 mg/dL, p = 0,048), mientras que las concentraciones de triglicéridos disminuyeron (227,1 mg/dL vs. 185.9 mg/dL, p = 0,007), lo cual persiste incluso una vez excluidos aquellos pacientes que se encontraban bajo tratamiento hipolipemiante (195 mg/dL vs. 171,6, p = 0,049). En cuanto al estado de dislipidemia, la hipertrigliceridemia disminuyó sin alcanzar la significancia (80,5 % vs. 62,5 %, p = 0,073). Conclusiones: la intervención nutricional mejoró las concentraciones de HDL y triglicéridos pasados 6 meses de la intervención en niños con ERC terminal.

Cardiometabolic Factors in Pediatric Patients with Chronic Diseases.

BACKGROUND: The prevalence of chronic diseases (CDs) in the pediatric population has increased due to technological advances that decrease mortality and increase survival. AIM OF THE STUDY: To compare the frequency of cardiometabolic factors (CFs) among pediatric patients with CDs with those among children with obesity and overweight without CDs. METHODS: This study was a cross-sectional study. Pediatric patients from 6-17 years of age were included. A total of 333 patients with CD were studied, and of these patients, 77 had difficult-to-control epilepsy, 183 had chronic kidney disease (CKD), and 73 underwent kidney transplants; in addition, a comparison group was included, consisting of 286 overweight and obese children without any other pathologies. We performed anthropometry, blood pressure, glucose, insulin, and lipid profiling on all of the patients. Statistical analysis was conducted as follows: Chi2 tests were used to compare the CFs between the groups. RESULTS: We included 619 patients from 6-17 years old. Patients with CDs had a low frequency of obesity (12.4%) but a high frequency of the remaining CFs. Hypertriglyceridemia (65%), hypoalphalipoproteinemia (49%) and systemic arterial hypertension (46.5%) were the most common CFs, particularly among subjects with CKD and kidney transplantation. When comparing the frequencies of these CFs with those in the obesity/overweight group, hypertriglyceridemia (p <0.05) was more common in patients with CDs. CONCLUSIONS: In patients with CDs, dyslipidemia, hypertension, and hyperglycemia occur at frequencies that are the same as or higher than those in overweight/obese children, but when the CD patients are overweight/obese, it increases their frequency.

[Cardiovascular risk factors in children with primary nephrotic syndrome]. / Factores de riesgo cardiovascular en niños con síndrome nefrótico primario.

BACKGROUND: It has been suggested that patients with nephrotic syndrome (NS) have an increased frequency of cardiovascular risk factors. The aim of this study was to determine the frequency of cardiovascular risk factors in children with primary NS. METHODS: Cross-sectional, descriptive and prospective study. Fifty-five patients with primary NS were included. The presence of overweight/obesity, hypertension, dyslipidemias, hyperglycemia, elevated C-reactive protein and carotid intima-media thickness (IMT) was evaluated. The treatment time, the type of treatment and the number of relapses were analyzed. For statistical analysis chi-square and Spearman's rho were used. RESULTS: The most frequent cardiovascular risk factor was increased carotid IMT (98.1 %), followed by hypertriglyceridemia (54.4 %) and total cholesterol (40 %). Patients with corticosensitive NS had fewer risk factors compared with patients with steroid-resistant NS. There was also a positive correlation of longer time of evolution and number of relapses with the increase in the number of factors. CONCLUSIONS: Ninety-eight percent of children with primary NS had at least one cardiovascular risk factor. Certain clinical features, such as steroid-resistant NS, and the time of evolution and treatment, seem to be related to the presence of larger number of risk factors.

Introducción: se ha propuesto que los pacientes con síndrome nefrótico (SN) tienen con mayor frecuencia factores de riesgo cardiovascular. El objetivo de este estudio fue determinar la frecuencia de factores de riesgo cardiovascular en niños con SN primario. Métodos: estudio transversal, descriptivo y prospectivo. Se incluyeron 55 pacientes con SN primario. Se evaluó la presencia de sobrepeso/obesidad, hipertensión, dislipidemia, hiperglicemia, elevación de proteína C reactiva (PCR) de alta sensibilidad y el incremento en el grosor intimo-medial carotídeo (GIM). Se analizó el tipo de SN, el tiempo de evolución, el tratamiento actual y el número de recaídas. Para el análisis estadístico se utilizó chi cuadrada y rho de Spearman. Resultados: el factor de riesgo cardiovascular más frecuente fue el incremento del GIM carotídeo (98.1 %), seguido de hipertrigliceridemia (54.4 %) y de hipercolesterolemia total (40 %). Los pacientes con SN corticosensible tuvieron menor número de factores de riesgo comparados con los corticorresistentes. Además hubo una correlación positiva de mayor tiempo de evolución y número de recaídas con el incremento de factores. Conclusiones: el 98 % de los niños con SN primario tuvieron al menos un factor de riesgo cardiovascular. Ciertas características clínicas como ser corticorresistentes y el tiempo de evolución y tratamiento parecen estar relacionadas con la presencia de un mayor número de factores de riesgo.