Key result
Citrulline-to-arginine ratio links to 24-hour BP in pediatric CKD, where ~67% exhibit abnormalities.
Why the study?
Major CV events are rare in young patients with CKD, prompting the use of surrogate markers and NO-related biomarkers to identify subclinical CVD and stratify CV risk.
Are nitric oxide pathway biomarkers and blood pressure abnormalities associated with subclinical cardiovascular disease indices in pediatric patients with chronic kidney disease?
Observational (n=125)
Are nitric oxide pathway biomarkers and blood pressure abnormalities associated with subclinical cardiovascular disease indices in pediatric patients with chronic kidney disease?
In pediatric patients with CKD, nitric oxide-related parameters and blood pressure abnormalities are associated with subclinical cardiovascular disease indices such as arterial stiffness and left ventricular mass.
BP abnormalities common in pediatric CKD with NO marker links; hypothesis-generating for interventional trials on citrulline-arginine ratio.
Cardiovascular disease (CVD) is common in chronic kidney disease (CKD), while major CV events are rare in young CKD patients. In addition to nitric oxide (NO)-related biomarkers, several surrogate markers have been assessed to stratify CV risk in youth with CKD, including 24-h ambulatory blood pressure monitoring (ABPM), carotid artery intima-media thickness (cIMT), pulse wave velocity (PWV), ABPM-derived arterial stiffness index (AASI), flow-mediated dilatation (FMD), and left ventricular mass index (LVMI). The aim of this study was to identify subclinical CVD through the analysis of indices of CV risk in children and adolescents with CKD. Between 2016 and 2018, the prospective observational study enrolled 125 patients aged 3 to 18 years with G1-G4 CKD stages. Close to two-thirds of young patients with CKD exhibited blood pressure (BP) abnormalities on ABPM. CKD children with abnormal office BP showed lower plasma arginine levels and arginine-to-asymmetric dimethylarginine (ADMA) ratio, but higher ratios of ADMA-to-symmetric dimethylarginine (SDMA) and citrulline-to-arginine. High PWV and AASI, indices of arterial stiffness, both strongly correlated with high BP load. Additionally, LV mass and LVMI exhibited strong correlations with high BP load. Using an adjusted regression model, we observed the citrulline-to-arginine ratio was associated with 24-h systolic and diastolic BP, systolic blood pressure (SBP) load, and diastolic blood pressure (DBP) load. Early assessments of NO-related parameters, BP load abnormalities, arterial stiffness indices, and LV mass will aid in early preventative care toward decreasing CV risk later in life for children and adolescents with CKD.
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Hsu et al. (2019) conducted an observational in Chronic kidney disease (n=125). Nitric oxide pathway biomarkers and blood pressure abnormalities was evaluated on Indices of cardiovascular risk including blood pressure load, arterial stiffness, and left ventricular mass. In 125 children and adolescents with CKD, nearly two-thirds exhibited blood pressure abnormalities, and the citrulline-to-arginine ratio was associated with 24-h systolic and diastolic BP.
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