Chronic kidney disease (CKD) by itself increases cardiovascular risk because of chronic inflammation and altered metabolism, the investigators say. But the presence of any additional risk factors—such as obesity, high cholesterol and hypertension—can further fuel that risk and put children with kidney disease on a path to early heart attack and stroke if left untreated, they add.
In the current multi-center study, which compared 101 children with kidney disease to 97 healthy children, the majority of patients with kidney disease had high blood pressure (87 percent) and elevated cholesterol (55 percent). One-quarter of them were overweight or obese.
Elevated cholesterol and chronically high blood pressure can cause fatty build-up inside the arteries and make them harder and stiffer. A narrowed carotid artery—the neck vessel that carries blood from the heart to the brain—not only restricts blood flow to the brain but is vulnerable to dangerous fatty plaque ruptures that can lead to heart attacks or strokes.
In their study, researchers performed neck ultrasounds to measure the internal thickness of the carotid artery. On average, children with kidney disease had carotid arteries about 0.02 millimeters thicker than those of children without kidney disease, but some children had arteries up to 0.06 millimeters thicker than their healthy counterparts. High blood pressure and elevated cholesterol increased the difference. Children with hypertension had arteries 0.04 millimeters thicker on average, and children with elevated triglyceride levels had arteries that were 0.05 millimeters thicker.
"We cannot emphasize this enough: Pediatricians who take care of children with chronic kidney disease—even kids with early-stage kidney disease—should screen them early for cardiovascular damage, assess their risk factors and treat hypertension and high cholesterol promptly and aggressively," Brady said.
An estimated 20 million Americans have CKD, according to the Centers for Disease Control and Prevention (CDC). Because CKD often evolves silently over a period of years, researchers estimate that many adults with late-stage or end-stage kidney disease developed the disease as children.