Dyslipidemia, carotid intima-media thickness and endothelial dysfunction in children with chronic kidney disease

Background Chronic kidney disease (CKD) predisposes to accelerated atherosclerosis that is measured by carotid artery intima-media thickness (cIMT) and brachial artery flow-mediated dilation (FMD). Information on the association of these parameters with dyslipidemia in pre-dialysis pediatric CKD is limited. Eighty patients aged 9.9 +/- 3.2 years, with estimated glomerular filtration rate of 38.8 +/- 10.8 ml/1.73 m(2)/min, and 42 pediatric controls underwent cross-sectional analysis of lipid profile, cIMT, and brachial artery FMD. Significant differences in these parameters between patients and controls were analyzed using Student's t test. Predictors of cIMT and dyslipidemia were assessed using linear and logistic regression respectively. Patients had elevated blood levels of triglyceride and of total and LDL cholesterol than controls (P a parts per thousand currency sign 0.001); 73.8 % were dyslipidemic. Mean cIMT was higher (0.421 +/- 0.054 mm vs 0.388 +/- 0.036 mm, P = 0.001) and brachial artery FMD was reduced (10.6 +/- 4.9 % vs 18.9 +/- 4.1 %, P < 0.0001) in patients compared with controls. On multivariate analysis, hypertension (OR 3.68, P = 0.044) and male gender (OR 10.21, P = 0.004) were associated with dyslipidemia; cIMT was significantly associated with LDL cholesterol (beta = 28.36, P = 0.033). Dyslipidemia was prevalent and cIMT significantly elevated in pre-dialysis pediatric CKD, indicating increased cardiovascular risk. Elevated LDL cholesterol predicted increased cIMT, strengthening the association between dyslipidemia and atherosclerosis in early CKD.