761 In pediatric dialysis patients in contrast to adult patients, however, CVD is usually asymp tomatic because these patients have a different disease composition compared with adults, and the CVD do[.]
39 Long-Term Outcome of Chronic Dialysis in Children In pediatric dialysis patients in contrast to adult patients, however, CVD is usually asymptomatic because these patients have a different disease composition compared with adults, and the CVD does not often result in serious outcomes such as ischemic heart disease or death Thus, surrogate markers, including left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and carotid artery intima-media thickness (CIMT), are most often used in clinical studies on CVD in pediatric dialysis patients There are also no guidelines specifically for the management of CVD in pediatric dialysis patients, other than those related to blood pressure management It is important to recognize that uncontrolled hypertension is the only proven modifiable factor that is associated with mortality secondary to CVD, and registry data from the USRDS and the ESPN/ERA-EDTA provide evidence that blood pressure management remains suboptimal [22, 23] 761 above, there have also been many reports of a high incidence of arrhythmia and vascular and valvular calcification in adult long-term dialysis patients [46–48] ong-Term Dialysis and CVD in Children L While there are fewer pediatric long-term dialysis patients compared with the adult dialysis population, there have been a few reports pertaining to children using the CVD surrogate markers of LVH and CIMT, which have addressed their relationship to the duration of dialysis Litwin et al measured the CIMT, the wall cross-sectional area (WCSA), and the lumen cross-sectional area (LCSA) using ultrasonography in 24 patients with CKD stages 3–5 (CKD group) and in 32 patients with ESKD (19 postHD renal transplant recipients [D-Rtx] and 13 HD patients [D-D]) who were less than 18 years old, and these parameters were normalized to standard deviation scores (SDS) The CIMT-SDS and WCSA-SDS were significantly higher in the Long-Term Dialysis and CVD in Adults patients with a history of dialysis compared to It is well known that CVD-related mortality is those with CKD (D-D 2.2 ± 1.4 years, D-Rtx high during the first year of dialysis in adult dial- 2.3 ± 1 year vs CKD 1.0 ± 1.5 years, P