Excess pounds weigh on heart of kids with CKD

Among children with chronic kidney disease (CKD), overweight and obesity appear to contribute to cardiac damage and left ventricular hypertrophy (LVH), and this effect is more pronounced in girls than in boys, as shown in a study.

The study included 725 children (median age, 11 years; 38 percent female; 21 percent black) with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study. This sample recorded a total of 1,483 study visits over a median follow-up of 3.3 years.

Median time with CKD was 8.0 years, and median estimated glomerular filtration rate was 52.6 mL/min/1.73 m². Average blood pressure was in the hypertensive range in 10 percent of the population. About 30 percent of the children were overweight or obese, and 11 percent had LVH. Median left ventricular mass index (LVMI) was 30.5 g/m^2.7, while median LVMI z score was 0.18.

Longitudinal analyses revealed that greater body mass index (BMI) z scores were associated with higher LVMI z scores and greater likelihood of LVH.

For each 1-unit increase in BMI z score, LVMI z score increased by 0.24 in boys and by 0.38 in girls (p_interaction=0.01). Likewise, each 1-unit increase BMI z score raised the odds of LVH by 1.5-fold in boys and by 3.1-fold in girls (p_interaction=0.005).

The findings suggest that paediatric overweight and obesity may have a substantial impact on CV risk among children with CKD, researchers said. As such, more studies are needed to examine whether improving and normalizing BMI in this population, particularly girls, may exert a beneficial effect on future CV risk.

The study had several limitations, including its observational nature. Also, not all children were subjected to repeated measurements, and LVH was a surrogate and not a hard cardiac outcome.