Risk Factors of Cardiovascular Disease among Children with Chronic Kidney Disease in Gaza strip

Abstract

Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. Cardiovascular disease (CVD) is a major cause of mortality in patients with mild to moderate CKD and end-stage renal disease (ESRD). There is accumulating evidence that the increase in CVD burden is present in CKD patients prior to dialysis, due to both conventional risk factors as well as those specific to kidney disease. Detection and initiation of treatment for CVD risk factors at earlier stages of CKD should be effective in reducing CVD events both before and after the onset of kidney failure. Therefore, this study aimed to assess a group of traditional CVD risk factors including, hypertension, diabetes, dyslipidemia, physical inactivity, body mass index (BMI), family history of CVD, and CKD-specific CVD risk factors including, hypoalbuminemia, albuminuria, anemia, Ca x P product, and inflammation (C-reactive protein), in CKD patients in Gaza strip, aged ≤12 years old and haven't undergone kidney replacement therapy. Patients of the study (40 male and 20 female) were categorized into 4 stages (2, 3, 4, and 5) where stage 1 was not encountered. Stage 4 had the highest distribution, followed by stage 3, stage 5 and stage 2. There were statistically significant differences between patients and controls in the terms of height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP), where the mean values indicated that the patients were shorter, had lower weight, higher SBP and DBP with 47% of the patients having hypertension. Frequency of physical inactivity among patients was 2-fold higher as compared to controls (50% vs. 25%). As compared to controls, patients had significantly higher means of cholesterol (163.6 ±39.8 vs. 141.8 ±24.2 mg/dl, p=0.001), triglycerides (145.5 ±67.1 vs. 82.9 ±39.8 mg/dl, p=0.000), Low density lipoprotein (LDL) (92.6 ±31.9 vs. 72.5 ±19 mg/dl, p=0.000), and they had lower means of high density lipoprotein (HDL) (41.9 ±11.0 vs. 52.7 ±11.7 mg/dl, p=0.000). As compared to controls, patients had significantly lower hemoglobin (9.8 ±1.4 vs. 11.9 ±0.8 g/dl, p=0.000), albumin (4.6 ±0.6 vs. 4.8 ±0.2 g/dl, p=0.012) and higher albumin/creatinine ratio (ACR) (1792 ±3183 vs. 11.1 ±6.6 mg/g, p=0.000). C- reactive protein (CRP) showed high occurrence among patients (40% were positive for CRP). Calcium and phosphorus evaluation showed significantly lower calcium and higher phosphorus among patients. However, Ca X P product was not statistically significant in patients compared to controls (52.4 vs. 53.4 mg2/dl2, p= 0.582). This study indicates that many of the CVD risk factors are associated with different stages of CKD in children patients prior to dialysis, and that these factors are exacerbated as CKD progresses.