TY - JOUR
T1 - Adiposity, Sex, and Cardiovascular Disease Risk in Children With CKD
T2 - A Longitudinal Study of Youth Enrolled in the Chronic Kidney Disease in Children (CKiD) Study
AU - Brady, Tammy M.
AU - Roem, Jennifer
AU - Cox, Christopher
AU - Schneider, Michael F.
AU - Wilson, Amy C.
AU - Furth, Susan L.
AU - Warady, Bradley A.
AU - Mitsnefes, Mark
N1 - Funding Information:
The CKiD Study is funded by the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (NHLBI; U01-DK-66143 , U01-DK-66174 , U24-DK-082194 , and U24-DK-66116 ). Dr Brady received funding from the NIH/NHLBI (K23-HL-119622 and R56-HL-139620). None of these funding sources had a role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.
Funding Information:
Tammy M. Brady, MD, PhD, Jennifer Roem, MS, Christopher Cox, PhD, Michael F. Schneider, MS, Amy C. Wilson, MD, MS, Susan L. Furth, MD, PhD, Bradley A. Warady, MD, and Mark Mitsnefes, MD, MS. Research idea and study design: TMB, MM, CC, JR, MFS; data analysis/interpretation: TMB, MM, CC, JR, MFS, SLF, BAW, ACW; supervision or mentorship: SLF, BAW, MM. Each author contributed important intellectual content during manuscript drafting or revision, accepts personal accountability for the author's own contributions, and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. The CKiD Study is funded by the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (NHLBI; U01-DK-66143, U01-DK-66174, U24-DK-082194, and U24-DK-66116). Dr Brady received funding from the NIH/NHLBI (K23-HL-119622 and R56-HL-139620). None of these funding sources had a role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication. The authors declare that they have no relevant financial interests. Received September 9, 2019. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor and an Associate Editor, who served as Acting Editor-in-Chief. Accepted in revised form January 17, 2020. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Publisher Copyright:
© 2020 National Kidney Foundation, Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Rationale & Objective: Traditional and nontraditional cardiovascular disease risk factors are highly prevalent in children with chronic kidney disease (CKD). We examined the longitudinal association of adiposity with cardiac damage among children with CKD and explored whether this association was modified by sex. Study Design: Prospective cohort study. Setting & Participants: Children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study at 49 pediatric nephrology centers across North America. Exposure: Age- and sex-specific body mass index (BMI) z score. Outcome: Age- and sex-specific left ventricular mass index (LVMI) z score and left ventricular hypertrophy (LVH). Analytical Approach: Longitudinal analyses using mixed-effects models to estimate sex-specific associations of BMI z scores with LVMI z score and with LVH, accounting for repeated measurements over time. Results: Among 725 children with 2,829 person-years of follow-up, median age was 11.0 years and median estimated glomerular filtration rate was 52.6 mL/min/1.73 m2. Nearly one-third of both boys and girls were overweight or obese, median LVMI z score was 0.18 (IQR: −0.67, 1.08), and 11% had LVH. Greater BMI z scores were independently associated with greater LVMI z scores and greater odds of LVH. For each 1-unit higher BMI z score, LVMI z score was 0.24 (95% CI, 0.17-0.31) higher in boys and 0.38 (95% CI, 0.29-0.47) higher in girls (Pinteraction = 0.01). For each 1-unit higher BMI z score, the odds of LVH was 1.5-fold (95% CI, 1.1-2.1) higher in boys and 3.1-fold (95% CI, 1.8-4.4) higher in girls (Pinteraction = 0.005). Limitations: Not all children had repeated measurements. LVH is a surrogate and not a hard cardiac outcome. The observational design limits causal inference. Conclusions: In children, adiposity is independently associated with the markers of cardiac damage, LVMI z score and LVH. This association is stronger among girls than boys. Pediatric overweight and obesity may therefore have a substantial impact on cardiovascular risk among children with CKD.
AB - Rationale & Objective: Traditional and nontraditional cardiovascular disease risk factors are highly prevalent in children with chronic kidney disease (CKD). We examined the longitudinal association of adiposity with cardiac damage among children with CKD and explored whether this association was modified by sex. Study Design: Prospective cohort study. Setting & Participants: Children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study at 49 pediatric nephrology centers across North America. Exposure: Age- and sex-specific body mass index (BMI) z score. Outcome: Age- and sex-specific left ventricular mass index (LVMI) z score and left ventricular hypertrophy (LVH). Analytical Approach: Longitudinal analyses using mixed-effects models to estimate sex-specific associations of BMI z scores with LVMI z score and with LVH, accounting for repeated measurements over time. Results: Among 725 children with 2,829 person-years of follow-up, median age was 11.0 years and median estimated glomerular filtration rate was 52.6 mL/min/1.73 m2. Nearly one-third of both boys and girls were overweight or obese, median LVMI z score was 0.18 (IQR: −0.67, 1.08), and 11% had LVH. Greater BMI z scores were independently associated with greater LVMI z scores and greater odds of LVH. For each 1-unit higher BMI z score, LVMI z score was 0.24 (95% CI, 0.17-0.31) higher in boys and 0.38 (95% CI, 0.29-0.47) higher in girls (Pinteraction = 0.01). For each 1-unit higher BMI z score, the odds of LVH was 1.5-fold (95% CI, 1.1-2.1) higher in boys and 3.1-fold (95% CI, 1.8-4.4) higher in girls (Pinteraction = 0.005). Limitations: Not all children had repeated measurements. LVH is a surrogate and not a hard cardiac outcome. The observational design limits causal inference. Conclusions: In children, adiposity is independently associated with the markers of cardiac damage, LVMI z score and LVH. This association is stronger among girls than boys. Pediatric overweight and obesity may therefore have a substantial impact on cardiovascular risk among children with CKD.
KW - Cardiovascular disease (CVD)
KW - adiposity
KW - adolescents
KW - body mass index (BMI)
KW - cardiac target organ damage
KW - children
KW - chronic kidney disease (CKD)
KW - hypertension
KW - left ventricular hypertrophy (LVH)
KW - left ventricular mass index (LVMI)
KW - obesity
KW - overweight
KW - pediatrics
KW - sex differences
KW - youth
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U2 - 10.1053/j.ajkd.2020.01.011
DO - 10.1053/j.ajkd.2020.01.011
M3 - Article
C2 - 32389356
AN - SCOPUS:85084998539
SN - 0272-6386
VL - 76
SP - 166
EP - 173
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -