Cardiovascular disease risk among children with focal segmental glomerulosclerosis: a report from the chronic kidney disease in children study

Abstract

Background: The aims were to compare the cardiovascular disease (CVD) risk among children with chronic kidney disease (CKD) secondary to focal segmental glomerulosclerosis (FSGS) with the CVD risk of children with CKD due to other diagnoses.

Methods: Casual blood pressure (BP), ambulatory blood pressure monitoring (APBM), echocardiogram, lipids, carotid intima medial thickness (cIMT), and uric acid obtained from participants in the Chronic Kidney Disease in Children (CKiD) cohort were analyzed longitudinally. Seventy-nine children with FSGS (FSGS-CKD) were compared to 196 children with non-FSGS glomerular disease (GDO-CKD) and 616 children with non-glomerular disease (NG-CKD).

Results: At baseline, FSGS-CKD (median 14 years) had ambulatory hypertension (24.6%), masked hypertension (46.2%), left ventricular hypertrophy (LVH) (26.3%), and dyslipidemia (60.0%). In adjusted models, FSGS-CKD had higher systolic BP z-score (0.52 vs 0.11 and 0.23, p = 0.002 and 0.02), triglycerides (133 vs 109 and 102 mg/dl, p = 0.007 and < 0.001), and non-high density lipoprotein (144 vs 132 and 119 mg/dl, p = 0.07 and < 0.001) at baseline when compared to GDO-CKD and NG-CKD, respectively. Left ventricular mass index (LVMI) (36.0 vs 31.7 g/m^2.7, p < 0.001) and the odds of LVH (OR 3.38, 95% CI 1.42, 8.08) at baseline were greater in FSGS-CKD compared to NG-CKD. Adjusted longitudinal analysis showed that FSGS-CKD had a faster decline in LVMI than NG-CKD, and FSGS-CKD had a faster increase in uric acid compared to both groups.

Conclusions: Children with CKD due to FSGS had a relatively high prevalence of CVD risk factors. FSGS was associated with greater CVD risk when compared to other CKD diagnoses.

Keywords: Carotid intima medial thickness; Dyslipidemia; Glomerular disease; Hypertension; Left ventricular hypertrophy; Pediatrics.

Figure 1.

Longitudinal changes in cardiovascular indicators based adjusted³ linear mixed effects models with random intercepts and random slopes comparing CKD diagnosis groups. Dashed horizontal bar: Intercept statistically different (p < 0.05) from FSGS-CKD group. Dashed vertical bar: Slope (or annual % change) statistically different from FSGS-CKD group.a Models were adjusted for age (all outcomes except for LVMi), sex, race, overweight/obese status, cohort wave and eGFR (log transformed). For interpretation of intercept, the reference characteristic was for a non-black, 10 year old normal weight boy from cohort wave 1 whose eGFR at baseline was 45 ml/min|1.73m2; for LVMI model: time-updated height (centered at 150 cm) was included instead of age as a covariate CKD - chronic kidney disease; FSGS - focal segmental glomerulosclerosis; G - glomerular; NG - non-glomerular; SBP - systolic blood pressure; DBP - diastolic blood pressure; BMI - body mass index;