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J Am Soc Nephrol 13:2953-2961, 2002
© 2002 American Society of Nephrology

Increased Arterial Stiffness in Young Adults with End-Stage Renal Disease since Childhood

Jaap W Groothoff*, Mariken P Gruppen*, Martin Offringa{dagger}, Eric de Groot{ddagger}, Willem Stok§, Willem Jan Bos, Jean Claude Davin*, Marc R Lilien||, Nicole Caj van de Kar#, Eric D Wolff& and Hugo S. Heymans{dagger}

*Department of Pediatric Nephrology and {dagger}Department of Pediatrics, Emma Children’s Hospital, Amsterdam, the Netherlands; {ddagger}Vascular Medicine Group, §Department of Physiology, Academic Medical Center, Amsterdam, the Netherlands; St. Antonius Hospital, Nieuwegein, the Netherlands; ||Department of Pediatric Nephrology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands; #University Medical Center St. Radboud, Department of Pediatric Nephrology, Nijmegen, the Netherlands; &Sophia Children’s hospital, Department of Pediatric Nephrology, Rotterdam, The Netherlands.

Correspondence to Dr. JW Groothoff, Dept. of Pediatric Nephrology, Emma Children’s Hospital AMC, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. Phone: 31205662727; Fax: 31206917735;E-mail: j.w.groothoff{at}amc.uva.nl

ABSTRACT. Increased arterial stiffness is a risk factor for mortality in adults over 40 yr of age with end-stage renal disease (ESRD). As no data exist on vascular changes in young adults with ESRD since childhood, a long-term outcome study was performed. All living Dutch adult patients with onset of ESRD between 1972 and 1992 at age 0 to 14 yr were invited for carotid artery and cardiac ultrasound and BP measurements. Data on clinical characteristics were collected by review of all medical charts. Carotid ultrasound data were compared with those of 48 age-matched and gender-matched healthy controls. Carotid artery and cardiac ultrasound was performed in 130 out of 187 eligible patients. Mean age was 29.0 (20.7 to 40.6) yr. Compared with controls, patients had a similar intima media thickness but a reduced mean arterial wall distensibility DC (40.0 versus 45.0 kPa-1 · 10-3; 95% CI, -9.1 to -0.8; P < 0.001), an increased stiffness parameter {beta} (4.2 versus 3.8; 95% CI, 0.05 to 0.68; P = 0.02), an increased elastic incremental modulus Einc (0.35 versus 0.27 kPa · 103; 95% CI, 0.02 to 0.12; P < 0.001). Multiple regression analyses in all subjects revealed that ESRD was associated with an increase in {beta} and Einc. Arterial wall properties of patients currently on dialysis and transplanted patients were comparable. In all patients, current systolic hypertension was associated with increased Einc and decreased DC. In conclusion, carotid arterial wall stiffness is increased in young adult patients with pediatric ESRD. Hypertension is a main determinant and might be a target for treatment of these potentially lethal arterial wall changes.




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