DYSLIPIDAEMIA IN CHILDREN ON DIALYSIS AND AFTER KIDNEY TRANSPLANTATION
Abstract
Cardiovascular complications are the main problems associated with end stage renal disease (ESRD) in adult, which began renal replacement therapy (RRT) in childhood. One of the factors contributing to this can be an imbalance of blood lipids.
Aim of the study was to evaluate changes in the lipid profile in children with ESRD, depending on the RRT method and age, and also after kidney transplantation depending on the glomerular filtration rate.
Materials and methods. In 91 children with ESRD at the age of 2–17 years who received peritoneal dialysis (PD) or hemodialysis (HD), or after kidney transplantation (Tx), total cholesterol (CH), triglycerides (TG), lipoproteins high density (HDL) ) were measured in 663 samples of blood and calculated fraction of non–HDL (CH – HDL). Dyslipidemia was defined as TG>1,13 mmol/1 (0–9years) and >1,47mmol/l (10–17years), CH> 5,18mmol/l, non–HDL >3,7mmol/l, HDL <1.0 mmol/l.
Results. The prevalence of dyslipidemia in children was 90,4% on PD, 65,2% on HD and 32,6% after Tx, mainly due to hypertriglyceridemia in 80,8% on PD, 65,2% on HD and 20,8% after Tx. The levels ofTG and non–HDL were also significantly higher in PD and HD patients than after Tx. Children of the younger age group (2–5 years) on PD had the worst lipid profile. After kidney transplantation a significant reduction of TG and cholesterol was detected in PD patients and only TG in HD patients. Reduction of the glomerular filtration rate in children after kidney transplantation is accompanied by an increase in TG levels.
Conclusion. Dyslipidemia is widespread in children on RRT. Preemptive kidney transplantation can prevent the development of severe lipid imbalance which persists of dialysis treatment.
Downloads
References
Ляликов С. А. Центильные характеристики антропометрических и лабораторных показателей у детей в современный период: инструкция по применению: утв. М–вом здравоохранения Респ. Беларусь 10.04.09 / С. А. Ляликов, А. В. Сукало, О. Е. Кузнецов; ГрГМУ, БГМУ, УЗ «ГрОКБ». – Гродно, 2009. – 94 с.
Annual summary of vital statistics: 2008 / T. J. Mathews, A. M. Minino, M. J. K. Osterman [et al.] // Pediatrics. – 2011. – Vol. 127, № 1. – P. 146–157.
CKiD Investigators: Dyslipidemia in children with chronic kidney disease / J.M. Saland, C. B. Pierce, M. M. Mitsnefes [et al.] // Kidney Int. – 2010. – Vol. 78, № 11. – P. 1154–1163.
Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease / A. S. Levey, J. A. Beto, B. E. Coronado [et al.] // Am. J. Kidney Dis. – 1998. – Vol. 32, № 5. – P. 853–906.
Dyslipidaemia in children on renal replacement therapy / M. Bonthuis, K. J. van Stralen, K. J. Jager [et al.] // Nephrol. Dial. Transplant. – 2014. – Vol. 29, № 3. – P. 594–603.
Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report // Pediatrics. – 2011. – Vol. 128, Suppl. 5. – P. 213–256.
Khurana M. Etiology and management of dyslip– idemia in children with chronic kidney disease and end–stage renal disease / M. Khurana, D. M. Silverstein // Pediatr. Nephrol. – 2015. – Vol. 30, № 12. – P. 2073–2084.
Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention / M.J. Sarnak, A. S. Levey, A. C. Schoolwerth [et al.] // Hypertension. – 2003. – Vol. 42, № 5. – P. 1050–1065.
Mitsnefes M. M. Cardiovascular disease in children with chronic kidney disease / М. М. Mitsnefes // J. Am. Soc. Nephrol. – 2012. – Vol. 23, № 4. – P. 578–585.
New equations to estimate GFR in children with CKD / G. J. Schwartz, A. Munoz, M. F. Schneider [et al.] // J. Am. Soc. Nephrol. – 2009. – Vol. 20, № 3. – P. 629–637.
US Renal Data System: USRDS 2011 [Электронный ресурс]. – Режим доступа : http:// www.usrds.org/atlas11.aspx – Дата обращения: 08.10.2017.
