Avaliação da espessura médio-intimal da carótida e fatores associados à doença cardiovascular em crianças e adolescentes com doença renal crônica

• Ano de defesa: 2017
• Autor(a) principal: Lopes, Renata [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Chronic renal failure; Cardiovascular diseases; Carotid intima-media thickness; Adolescents; Children; Insuficiência renal crônica; Doenças cardiovasculares; Espessura ínitma-média carotídea; Crianças; Adolescentes
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5477300; http://repositorio.unifesp.br/handle/11600/50380

Introduction: Cardiovascular complications are the leading cause of death in patients with chronic kidney disease (CKD). The measurement of carotid intima-media thickness (IMT) is a noninvasive tool for the early detection of arterial injury in these patients. The aim of the present study was to evaluate the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with CKD. Material and Methods: Observational cross-sectional study of 55 patients (60% male), with median age 11.9 years (I25-I75: 9.2 - 14.8 years). Out of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions and triglycerides), nutritional status (z-score of body mass index, height / age z score), body fat and abdominal circumference) and blood pressure were evaluated. The carotid IMT measure was evaluated by single ultrasonographer and compared to percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016. Results: 74.5% (95% CI: 61.0; 85.3) of children and adolescents with CKD presented an increase (above the 95th percentile) of the carotid IMT. In patients with stage I and II hypertension, 90.9% presented increased of the carotid IMT. The nutritional status and body fat were not associated with increased of the carotid IMT. Regarding laboratory tests, C-reactive protein and uric acid were elevated in 54.5% and 45.5% of patients with CKD, respectively, both of which were no association with the increase of the carotid IMT. After multivariate adjustment, only the puberty (RP = 1.30, p = 0.037) and arterial hypertension stages I and II (RR = 1.42, p = 0.011) were independently associated to the change in the carotid IMT. Conclusion: The prevalence of increased carotid thickness was high in children and adolescents with CKD. The puberty and arterial hypertension were independently associated to the increased of the carotid IMT. The other factors related to cardiovascular disease in patients with CKD were not associated with carotid artery alteration in the ultrasound evaluation. The risk factors studied play an important role in CVD associated morbidity and mortality in children with CKD. Early and routine assessment of these factors, along with appropriate intervention are important in preventing CVD progression and mortality in these patients.