Background
High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and ...age interact and potentially impact BP after transplantation have not been investigated.
Methods
This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant.
Results
At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP
z
-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP
z
-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected.
Conclusions
BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls).
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Cardiovascular disease remains the most common cause of death worldwide, and early manifestations are increasingly identified in childhood and adolescence. With physical inactivity being the most ...prevalent modifiable risk factor, the risk for cardiovascular disease is deemed low in people engaging in regular physical exercise. The aim of this study was to investigate early markers and drivers of cardiovascular disease in young athletes pursuing a career in competitive sports.
One hundred and five athletes (65 males, mean age 15.7 ± 3.7 years) were characterized by measurement of body impedance to estimate body fat, blood pressure (BP), carotid femoral pulse wave velocity (PWV) to evaluate arterial elasticity, ergometry to assess peak power output, echocardiography to calculate left ventricular mass, and blood tests.
Systolic BP was elevated in 12.6% and thereby more than twice as high as expected for the normal population. Similarly, structural vascular and cardiac changes represented by elevated PWV and left ventricular mass were found in 9.5% and 10.3%. Higher PWV was independently associated with higher systolic BP (
= 0.0186,
< 0.0001), which in turn was closely correlated to hemoglobin levels (
= 0.1252,
= 0.0435). In this population, increased left ventricular mass was associated with lower resting heart rate (
= -0.5187,
= 0.0052), higher metabolic equivalent hours (
= 0.1303,
= 0.0002), sport disciplines with high dynamic component (
= 17.45,
= 0.0009), and also higher systolic BP (
= 0.4715,
= 0.0354).
Despite regular physical exercise and in the absence of obesity, we found an unexpected high rate of cardiovascular risk factors. The association of PWV, systolic BP, and hemoglobin suggested a possible link between training-induced raised hemoglobin levels and altered vascular properties. Our results point toward the need for thorough medical examinations in this seemingly healthy cohort of children and young adults. Long-term follow-up of individuals who started excessive physical exercise at a young age seems warranted to further explore the potential adverse effects on vascular health.
Background:
Zinc-alpha 2-glycoprotein (AZGP1), a secreted protein with ubiquitous tissue expression, has been controversially linked to the risk of cardiovascular disease. In a cohort of kidney ...transplant recipients, we measured serum AZGP1 levels after transplantation over a 2 year period and tested for an association with pulse wave velocity as an important parameter indicating future cardiovascular events.
Methods:
Annual blood sampling and pulse wave velocity measurements were longitudinally performed in 113 kidney transplant recipients. AZGP1 was measured in serum samples using standard ELISA. Association of AZGP1 with pulse wave velocity was longitudinally assessed during follow up of 2 years by mixed longitudinal modeling.
Results:
AZGP1 serum levels declined significantly after kidney transplantation. This decline was dependent on allograft function as indicated by inverse correlation with eGFR. When corrected for eGFR multivariable analysis revealed an inverse correlation between AZGP1 and pulse wave velocity. This analysis further showed independent associations of older age, higher blood pressure, and higher calcium phosphate product with higher pulse wave velocity.
Conclusions:
Improved kidney function after transplantation leads to a decline in AZGP1 serum levels. Independent of kidney function and other cardiovascular risk factors lower AZGP1 levels are associated with higher pulse wave velocity in the 2 years after kidney transplantation. These data suggest that AZGP1 might be a potential biomarker for cardiovascular health and a target for improving cardiovascular outcome.
Objective: Cardiovascular risk factors, especially arterial hypertension, are very common after kidney transplantation (KTx) during childhood. Ambulatory blood pressure monitoring (ABPM) is the gold ...standard of hypertension diagnostics. The present study analyzes circadian and ultradian rhythms in ABPM and their association with left ventricular mass and aortic pulse wave velocity as markers of cardiovascular end organ damage. Design and method: From a prospective international multicenter observational study ABPMs of 151 children and adolescents after KTx could be analyzed. They were compared to a healthy cohort of 299 schoolchildren matched for gender and body length. Partial Fourier analysis was used to examine oscillatory fluctuations at 24, 12, 8 and 6 hours (h) period lengths in order to detect rhythms in both mean arterial pressure (MAP) and heart rate (HR). These rhythms could be further characterized in their amplitude as well as their acrophase which is the time interval until maximum amplitude after midnight. Results: In patients after KTx, a 12h rhythm in the MAP (figure panel A) and an 8h rhythm in HR were significantly more frequent than in healthy children. No difference in rhythm frequency was found for the other period lengths. Amplitudes in MAP were significantly smaller after KTx (24h, 8h, 6h) and MAP acrophases were significantly longer (24h, 12h, 8h) than in the control group (figure panel B and C). Significantly smaller amplitudes and longer acrophases were observed in the KTx cohort for HR as well. Data assessing cardiovascular end organ damage was available for children after KTx: We observed a positive correlation of 24h MAP amplitude with arterial pulse wave velocity (r=0.19; p=0.036) and a comparable trend with 8h MAP amplitude (r=0.31; p=0.053). Left ventricular mass did not correlate with any of the rhythm parameters after KTx. Conclusions: Our analysis demonstrates altered circadian and ultradian cardiovascular rhythmicity after KTx. Compared to healthy children, the described rhythms are flattened and delayed. Interestingly, there was a correlation of MAP amplitudes with vascular stiffness that warrants further investigation. Hence, we are going to analyze follow-up ABPM measurements in the described cohort after KTx.
Objective: Cardiac alterations and complications are common after pediatric kidney transplantation (KTx). In adults, myocardial fibrosis is an established surrogate marker for cardiac mortality. ...Non-contrast native T1 time (nT1) in cardiac MRI offers the possibility to detect structural myocardial changes. Data for children after KTx is not available yet. We aimed to assess function and structure in cardiac MRI in pediatric KTx-recipients with a focus on nT1. Design and method: 46 KTx-recipients (mean age 16±3.5 years; 7.9±5.3 years after KTx) and 46 sex- and age- matched healthy controls were examined with gadolinium-free cardiac MRI. nT1 and T2 time were measured at the interventricular septum (basal and mid-ventricular short-axis slice). Further parameters derived from MRI were: left ventricular mass index (LVMI), left ventricular ejection fraction (LV-EF) and global longitudinal strain (GLS). Multivariable linear regression analysis (co-variates: age, sex, height) was used to evaluate the association between nT1 and clinical parameters. Results: KTx-recipients had a significant higher nT1 than healthy controls (1198±48.8ms vs. 1155±23.4ms; p< 0.001). In 22 KTx-patients (48%) nT1 values were above the total range of controls. T2 time showed no significant difference between the groups. KTx-recipients showed a higher LVMI z-score (LVMIz), a higher LV-EF and a lower GLS. Higher nT1 was associated with systolic blood pressure (SBP; ß=1.28; p=0.001; Fig. 1), LVMIz (ß=1.55, p<0.001) and LV-EF (ß=3.52, p=0.026) only in patients, but not in controls. Further evaluation of KTx-recipients revealed that nT1 tended to be higher with longer time on dialysis, no association was seen for time since KTx. Conclusions: Our data suggest the presence of cardiac remodeling with myocardial fibrosis in a significant proportion of young KTx recipients. Non-contrast CMR imaging has the potential as a diagnostic adjunct in the follow-up of KTx recipients for a better risk stratification. Longitudinal studies are needed to evaluate if preventive targeting of associated factors, especially optimization of BP control, might reduce the prevalence of sudden cardiac death in young KTx recipients.
Lactose malabsorption and lactose-induced symptoms are poorly correlated, as shown by breath tests and various symptom assessment methods. Validated assessment is the key to overcome the limitations ...of biased symptom measurements. We characterized lactose-induced symptoms with the population-specific, validated paediatric carbohydrate perception questionnaire (pCPQ) and their correlation with the history of symptoms (HoS).
A total of 130 patients with functional gastrointestinal symptoms underwent a lactose hydrogen breath and tolerance test (LBTT) allowing for a diagnosis of malabsorption (M+) and lactose sensitivity (S+). HoS indicative of lactose-induced symptoms (abdominal pain, nausea, bloating, flatulence, diarrhoea) in the 4 weeks preceding the test was determined using a validated questionnaire. The pCPQ was used to score lactose-induced symptoms.
The LBTT revealed 41 children (31.5%) with lactose malabsorption (M+), 56 (43.1%) with lactose sensitivity (S+) and 24 (18.5%) were M+/S+. Sensitivity correlated with HoS (P < 0.001), regardless of whether malabsorption was detectable. Malabsorption status did not correlate with HoS (NS). The odds of lactose sensitivity significantly increased when abdominal pain odds ratio (OR) 3.5, confidence interval (CI) 1.6-7.8, nausea (OR 2.3, CI, 1.1-4.9) and flatulence (OR 3.1, CI 1.4-6.8) were reported in the 4 weeks preceding the LBTT. Symptoms after the lactose load were similar for M+/S+ and M-/S+, except for flatulence, which was more frequent in malabsorbers (P < 0.01).
Our findings fit well with the emerging view of the important role of a validated symptom assessment after a lactose load. The determination of symptoms may be more relevant than malabsorption for the clinical outcomes of paediatric patients with lactose-related gastrointestinal symptoms.
ABSTRACT
Objectives:
The relevance of methane measurement in breath tests for the detection of carbohydrate malabsorption in children is controversial. The need for correction for poor sample ...collection is disputed. We evaluated the relevance of methane/CO2 measurements for the diagnosis of paediatric carbohydrate malabsorption.
Methods:
A total of 132 breath tests (fructose: n = 54; lactose: n = 78) were performed in 91 children/adolescents with functional abdominal complaints. Breath samples were collected and analysed for hydrogen, methane, and CO2. Malabsorption was defined by a net increase over baseline of ≥20 parts per million (ppm) for hydrogen, ≥5 to ≥12 ppm for methane, and ≥10 to ≥15 ppm for hydrogen‐plus‐methane. The diagnosis was made before and after the use of a CO2‐based correction factor (5.5% as the numerator). Hydrogen‐based test results were compared with results obtained with other cut‐off values.
Results:
Fifty‐eight positive tests were obtained by hydrogen measurement (without CO2 correction). The addition of methane measurements did not significantly influence the test results (P > 0.05). Only under the use of extraordinary cut‐offs (combined hydrogen‐plus‐methane smaller than ≥18 ppm) did the rate of malabsorbers increase significantly (P < 0.05). After CO2 correction, hydrogen ≥20 ppm was detected in 4 additional patients, but 1 patient lost the hydrogen‐based diagnosis of malabsorption (Cohen kappa = 0.92).
Conclusions:
Methane measurement did not significantly affect the detection rate of carbohydrate malabsorbers in children/adolescents with functional abdominal complaints when established cut‐offs are used. The use of CO2 correction altered the diagnosis of malabsorption in a minority of patients but did not significantly alter overall test results.
Full text
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Organ transplantation as an option to overcome end-stage diseases is common in countries with advanced healthcare systems and is increasingly provided in emerging and developing countries. A review ...of the literature points to sex- and gender-based inequity in the field with differences reported at each step of the transplant process, including access to a transplantation waiting list, access to transplantation once waitlisted, as well as outcome after transplantation. In this review, we summarize the data regarding sex- and gender-based disparity in adult and pediatric kidney, liver, lung, heart, and hematopoietic stem cell transplantation and argue that there are not only biological but also psychological and socioeconomic issues that contribute to disparity in the outcome, as well as an inequitable access to transplantation for women and girls. Because the demand for organs has always exceeded the supply, the transplant community has long recognized the need to ensure equity and efficiency of the organ allocation system. In the spirit of equity and equality, the authors call for recognition of these inequities and the development of policies that have the potential to ensure that girls and women have equitable access to transplantation.
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