Thrombomodulin as a New Marker of Endothelial Dysfunction in Chronic Kidney Disease in Children.

Endothelial dysfunction (ED) and oxidative stress are potential new pathomechanisms of cardiovascular diseases in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between endothelial dysfunction, oxidative stress biomarkers, and cardiovascular risk factors in children with CKD. Serum oxidized LDL (oxLDL), protein carbonyl group, urea, creatinine, cystatin C, thrombomodulin, asymmetric dimethylarginine (ADMA), von Willebrand factor, brain natriuretic peptide (BNP), lipids, high sensitivity C-reactive protein, intercellular adhesion molecule-1 levels, and albuminuria were measured. Anthropometric, ambulatory blood pressure (BP) measurements and echocardiography were performed. The studied group consisted of 59 patients aged 0.7-18.6 (mean 11.1) years with stages 1 to 5 CKD. Thrombomodulin strongly correlated with creatinine (R = 0.666; p < 0.001), cystatin C (R = 0.738; p < 0.001), BNP (R = 0.406; p = 0.001), ADMA (R = 0.353; p = 0.01), oxLDL (R = 0.340; p = 0.009), 24-hour systolic (R = 0.345; p = 0.011) and mean (R = 0.315; p < 0.05) BP values, and left ventricular mass index (LVMI, R = 0.293; p = 0.024) and negatively with estimated glomerular filtration rate (R = -0.716; p < 0.001). In children with CKD, TM strongly depended on kidney function parameters, oxLDL levels, and 24-hour systolic and mean BP values. Thrombomodulin seems to be a valuable marker of ED in CKD patients, correlating with CKD stage as well as oxidative stress, BP values, and LVMI.

Assessment of sleep disorders among patients with hypertension and coexisting metabolic syndrome.

PURPOSE: The coexistence of hypertension, abdominal obesity, and carbohydrate and lipid metabolism disturbances favors the acceleration of other disease entities - also apart from cardiovascular system disorders. This study was planned to estimate the relationship between the presence of metabolic syndrome and sleep disorders among a group of hypertensive patients. PATIENTS/METHODS: The study was conducted on unselected group of 261 patients from the Outpatient Hypertension Clinic. The standardized questionnaire was used to collect the data on medical history, prescribed drugs and lifestyle. Sleep disorders were diagnosed based on the Athens Insomnia Scale and STOP-Bang Questionnaire. According to the study protocol, anthropometric parameters (weight, height, waist and neck circumferences), blood pressure, serum lipids and fasting glucose laboratory measurements were performed. Metabolic syndrome was defined according to IDF criteria. RESULTS: Sleep disorders were recognized in 183 participants of the study - significantly more frequently (P=0.03) among patients with diagnosed metabolic syndrome (120; 75%) in comparison with participants without this disturbance (63; 62.38%). Male gender, poor financial situation, tingling sensations before falling asleep and combination therapy of hypertension significantly increased the risk of sleep disorder occurrence in the group of patients with metabolic syndrome. Night food intake, aging, hypertension combination therapy and poor socioeconomic status were the factors increasing the risk of sleep problems among participants without metabolic syndrome. CONCLUSIONS: Sleep disorders often coexist with metabolic syndrome in hypertensive patients. A number of factors increase the probability of occurrence of sleep disorders, but most of them are modifiable.

Relationship between water compartments, body composition assessed by bioelectrical impedance analysis and blood pressure in school children.

BACKGROUND: Electrical bioimpedance analysis (BIA) is becoming more widely used in clinical practice as a method of body composition analysis. In healthy children blood pressure (BP) changes with age, body mass and height. Until now the relation between water compartments and BP in healthy children has not been evaluated. The aim of this study was to evaluate the relationship between body composition as well as water compartments (measured by electrical bioimpedance) and BP. METHODS: The study was performed in 72 children (32 girls and 40 boys) aged: 6-7 and 12-13 years. BIA measurements were taken using Nutriguard Data Input device with Bianostic electrodes and following parameters were calculated: total body water (TBW), lean body mass (LBM), fat mass (FM), intra- and extracellular water (ICW, ECW) and phase angle alpha. BP was measured twice using the oscillometric method. RESULTS: Elevated BP > 95th percentile for gender, age and height were observed in 9 children. A significant correlation between systolic (S)BP and TBW (R = 0.4023, p < 0.001), LBM (R = 0.3600, p = 0.002), FM (R = 0.4725, p < 0.001), ECW (R = 0.4598, p < 0.001) and body mass index (BMI) (R = 0.4089, p < 0.001) was found. Furthermore, diastolic (D)BP significantly correlated with TBW (R = 0.3056, p = 0.011), LBM (R = 0.2783, p = 0.021), FM (R = 0.3956, p < 0.001), ECW (R = 0.3869, p = 0.001) and BMI (R = 0.3550, p = 0.002). In the studied group malnutrition (weight < 3rd percentile) was found in 8 children and 2 had obesity (BMI > 95th percentile). Growth disorders were found in 6 children (5 of them being undernourished). CONCLUSIONS: In the studied children SBP and DBP correlated with water compartments, lean body and fat masses derived from BIA. The problem of unrecognized hypertension and malnutrition in children and adolescents is still underestimated in the Polish population.

Oxidative Stress Biomarkers and Left Ventricular Hypertrophy in Children with Chronic Kidney Disease.

Cardiovascular diseases remain the most frequent cause of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between oxidative stress biomarkers and cardiovascular risk factors and left ventricular hypertrophy in children with CKD. Material and Methods. The studied group consisted of 65 patients aged 1.4-18.6 (mean 11.2) years with stages 1 to 5 CKD. Serum oxidized low-density lipoprotein (oxLDL), protein carbonyl group, creatinine, cystatin C, albumin, lipids, high-sensitivity C-reactive protein, intercellular adhesion molecule-1, insulin, plasma renin activity, and aldosterone levels were measured. Patients were divided into groups depending on CKD stage. Anthropometric measurements, ambulatory blood pressure (BP) measurements, and echocardiography with left ventricular mass (LVM) calculation were performed. Results. Serum oxLDL strongly correlated with creatinine (R = 0.246; p = 0.048), cystatin C (R = 0.346; p = 0.006), total cholesterol (R = 0.500; p < 0.001), triglycerides (R = 0.524; p < 0.001), low-density lipoprotein concentrations (R = 0.456; p < 0.001), and 24 hour BP values of systolic (R = 0.492; p = 0.002), diastolic (R = 0.515; p < 0.001), and mean arterial pressure (R = 0.537; p < 0.001). A significant correlation between oxLDL levels and LVM z-scores (R = 0.299; p = 0.016) was found. Conclusions. Hypertension and dyslipidemia correlated with lipid oxidation in children with CKD. oxLDLs seem to be valuable markers of oxidative stress in CKD patients, correlating with left ventricular hypertrophy.

[Office and 24-hour ambulatory blood pressure measurements in hypertension assessment in children with chronic kidney disease].

Introduction: Hypertension (HT) is one of the major risk factors of chronic kidney disease (CKD) progression and cardiovascular complications. The aim of the study was to analyze blood pressure (BP) values and assess the usefulness of clinical measurements in BP monitoring in children with chronic kidney disease. Material and methods: The study was conducted in 62 children (40 boys and 22 girls) aged 4,2-18,6 years (median age 12.4 (9.1; 16.0) with CKD stages 1 + 2 (n = 9), 3 (n = 17), 4 (n = 15) and 5. Creatinine concentration was measured and glomerular filtration rate was calculated using the Schwartz formula. Each of the patients underwent clinical BP measurements and 24-hour ambulatory blood pressure monitoring (ABPM). Results: Based on clinical meaurements elevated BP values were found in 25 patients (40.3%): in stages 1 + 2 in 33.3%, in stage 3 in 41.2%, in stage 4 in 46.6% and in stage 5 in 38.1% patients. Hypertension was diagnosed with ABPM in 30 patients (48.4% of the studied population): in stages 1 + 2 - 3 patients (33.3%), in stage 3 - 8 patients (47, 1%), in stage 4 - 7 patients (46.7%) and stage 5 - 12 patients (57.1%). Only 12 patients (19.4%) had hypertension diagnosed in both clinical and ABPM measurements. White coat effect was found in 13 children (21.0%) and masked HT in 18 children (29.0%). In 24-hour BP monitoring the highest values of systolic, diastolic and mean BP values were found in children with masked HT. In children with masked HT higher values of 24-hour systolic (120 vs. 105.5 mmHg, p<0.001) and diastolic (75 vs. 65 mmHg, p<0.001) BP compared with clinical values were detected. Children with masked HT had significantly higher nighttime diastolic BP compared with children with HT (1.43 vs. 0.74 z-score, p<0.001). Conclusions: The large percentage of children with masked hypertension is an indication for frequent ABPM measurements in children with chronic kidney diseses. Office measurements are not sufficient to detect HT in children with CKD. The best diagnostic method to confirm and monitor hypertension in patients with CKD is 24-hour ambulatory blood pressure monitoring.

[Do we successfully treat anemia and calcium-phosphate disorders in children with chronic kidney disease at the beginning of the twenty-first century?]. / Czy na poczatku XXI wieku skutecznie leczymy niedokrwistosc i zaburzenia wapniowo-fosforanowe u dzieci z przewlekla choroba nerek?

UNLABELLED: In children with chronic kidney disease (CKD) anemia and calcium-phosphate disturbances are already present at early stages of the disease and require a comprehensive treatment. The aim of this study was to evaluate the efficacy of the treatment of biochemical disturbances, depending on the severity of CKD in children. MATERIAL AND METHODS: The study included 71 children (44 boys, 27 girls) with CKD stage 1-5. Mean age was 11 ± 5 years, mean height: 135.7 ± 28 cm and mean eGFR 32 ml/min/1.73 m2. The serum hemoglobin, urea, creatinine, cystatin C, calcium, phosphorus and parathyroid hormone (PTH) levels were measured. eGFR was calculated according to Schwartz and Filler formulas, employing creatinine and cystatin C as markers. Patients were divided into groups depending on the stage of CKD [group 1: CKD stage 1+2 (GFR > 60), group 2: CKD stage 3 (GFR = 30-59) Group 3: CKD stage 4 (GFR = 15-29 ml/min/1.73 m2), group 4 - dialyzed children]. RESULTS: The concentration of he- moglobin depending on the stage of CKD (group 1 vs. group 2 vs. group 3 vs group 4) was 12.95 vs. 12.68 vs. 12.47 vs. 11.3 g/dI, respectively. The concentration of total and ionized calcium was significantly lower in children on dialysis compared to patients treated conservatively. With the progression of CKD the concentration of phosphorus (1.39 vs. 1.4 vs. 1.49 vs. 1.82 mmolI) and PTH (21.7 vs 48.6 vs 99.9 vs. 219 pg/ml) significantly increased. Treatment with erythropoietin was used in 48% of children, calcium carbonate in 55% and alphacalcidol in 56% of patients. CONCLUSIONS: Despite the use of regular treatment, with the progression of CKD a progression of anemia, increased serum phosphate and parathyroid hormone and a decrease in calcium levels in studied children was observed. The severity of metabolic disorders in dialyzed children indicates the need for administration of new and more effective drugs, to prevent early enough complications of CKD in the form of mineral bone disease and cardiovascular complications.

[Hypertension in early school aged children born prematurely with extremely low birth weight]. / Nadcisnienie u dzieci w wieku wczesnoszkolnym urodzonych ze skrajnie mala masa urodzeniowa.

BACKGROUND: Infants born with extremely low birth weight < or =1000 g (ELBW) are endangered by many complications. AIM: To assess whether infants born prematurely with ELBW are pre. disposed to arterial hypertension (HT) in a 7-year follow up examination. MATERIAL AND METHODS: A group of 57 children (38 girls, 19 boys) at the age of 6.6+/-0.4 years was analyzed. Mean gestational age was 27.4+/-2 Hbd. All infants were born with ELBW (the mean weight was 861+/-127 g). The con. trol group consisted of 36 children (19 girls and 15 boys; the mean age was 7+/-0.9 years) born on time, with the mean birth weight 3559 g. The Ambu. latory Blood Pressure Measurement (ABPM) was performed in both groups. Mean arterial pressure (MAP), the night blood pressure (BP) decrease, BP. load, heart rate (HR) and presence of HT were analyzed. RESULTS: Children born prematurely were significantly shorter than children from the control group (116 vs 125 cm; p<0.0001). HT diagnosis based both on MAP (15% vs 0%; p<0.02) and on BP loads (51% vs 22%; p<0.006), was significantly more common in the group of preterm infants. Moreo. ver, systolic BP-load (28% vs 17%; p<0.01), diastolic BP-load (27% vs 18%; p<0.01), daytime HR (99 vs 94/ min; p=0.01), nighttime HR (86 vs 791 min; p<0.001) and daily HR (93 vs 87/ min; p<0.001) were also significantly higher in the preterm group. Difference in night BP drops in both groups did not reach statistical significance. In the group of former preterms there was no correlation between birth weight or intrauterine growth and BP value. BP values: systolic (105 vs 100 mm Hg; p<0.02), diastolic (66 vs 63 mm Hg; p<0.01) and MAP (80 vs 76 mm Hg; p<0.01) were significantly higher in girls than in boys born prematurely with ELBW. CONCLUSION: Infants born with ELBW are latterly predisposed to HT. Hypertension is more frequent in prematurely born girls. It is important to control BP in this group of children because early diagnose helps to decrease the risk of multiple organ complications caused by HT.