Risco cardiovascular em crianças e adolescentes com doença renal crônica no momento do transplante renal

• Ano de defesa: 2016
• Autor(a) principal: Val, Maria Luiza Dautro Moreira do [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 kidney failure; Cardiovascular disease; Child; Adolescent; Corotid intima-media thickness; Echocardiography; Insuficiência renal crônica; Doença cardiovascular; Criança; Adolescente; Espessura íntima-média carotídea; Ecocardiografia
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4264824; http://repositorio.unifesp.br/handle/11600/46479

Objective: To test whether there is cardio circulatory impairment in children and adolescents with chronic kidney disease (CKD) Stage 5 at the time of renal transplantation. In addition, we tried to characterize what were the main risk factors associated with this outcome. Methods: Observational, transversal, with 69 children and adolescents at the time of renal transplantation and 33 healthy subjects matched for age and sex. The study endpoints were: a) left ventricular mass and b) measurement of the intima--?media complex of the carotid artery. Potential risk factors considered were age, sex, CKD etiology, use of vitamin D and calcium--?based phosphate binders, systolic blood pressure and diastolic blood pressure, Z--?scores for body mass index, diagnosis time, time dialysis, serum ionized calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF23), uric acid, homocysteine, cholesterol, triglycerides, C--?reactive protein, serum levels of vitamin D and Hemoglobin. Results: The Z score of left ventricular mass (ZLVM) was 0.48 (SD = 1.75) in patients with CKD and --?0.94 (SD = 1.0) denoting a statistically significant difference between groups (p <0.001). In multivariable analysis, dialysis time, age, systolic blood pressure, the level of serum hemoglobin and HDL were the factors associated with ZLVM. Regarding the carotid intima--?media thickness (CIMT), we noted significant differences CIMT measure between the groups, with 0.52 (0.09) mm in patients With CKD and 0.46 (0.07) mm in controls (p = 0.003). In multivariable analysis, only systolic blood pressure was associated with a measure of CIMT. Conclusion: Children with CKD show cardiac involvement at the time of renal transplantation. The two outcomes studied showed independent association of systolic blood pressure and strict control of blood pressure has the potential to minimize the severity of cardio circulatory involvement in children with CKD.