Simultaneous reversal of risk factors for cardiac death and intensified therapy in long-term survivors of paediatric end-stage renal disease over the last 10 years

BACKGROUND: In an extended long-term follow-up of patients on chronic renal replacement therapy (RRT) since childhood (LERIC study), we observed a substantial reduction in cardiovascular (CV) death over the last decade. In this study, we investigated the contemporaneous changes in risk factors for CV death and cardioprotective therapy. METHODS: The cohort consisted of 140 Dutch patients, who were born before 1979 and started RRT before 15 years of age between 1972 and 1992. We compared the prevalence of various factors in 2000 and 2010 by calculating matched odds ratios (OR(matched)). RESULTS: Median age of patients was 38.5 years (range 23.2-50.8) in 2010, after a median time on RRT of 28 years. The prevalence of CV risk factors decreased from 41.3% in 2000 to 18.8% in 2010. The OR(matched) in 2010 compared with 2000 for left ventricular hypertrophy, hypertension and hypercholesterolaemia were 0.26 (95% CI 0.09-0.66), 0.22 (95% CI 0.01-0.59) and 0.04 (95% CI 0.01-0.25), respectively. The rate of nonfatal CV events dropped, although not significantly, from 1.75/100 (95% CI 1.3-2.4) per patient year (py) in 1972-2000 to 0.95/100 (95% CI 0.5-1.7) py in 2000-2010. ACE inhibitors/angiotensin receptor blockers and cholesterol lowering medication were prescribed significantly more often in the period 2000-10 [OR(matched) = 7.40 (95% CI 2.90-24.10) and 11.5 (95% CI 4.20-43.90)]. Trends were similar among those who survived and those who did not survive the last decade. CONCLUSIONS: We observed a decrease in clinical CV disease synchronous to intensified antihypertensive and antidyslipidaemic therapy in long-term survivors of paediatric renal failure. This advocates a vigorous cardioprotective management in these patients.