Document Type

Journal Article

Publication Date

2-1-2018

Journal

Clinical Kidney Journal

Volume

11

Issue

1

Inclusive Pages

136-146

DOI

10.1093/ckj/sfx056

Grant Information

CTSI FUNDED.

Supported by the National Institutes of Health (NIH) (R01HD071981 [to A.K. and S.M.]), NIH National Center for Research Resources and the National Center for Advancing Translational Sciences (UL1TR000003, UL1TR001876), and Research Electronic Data Capture (REDCap).

Abstract

Children are at increased risk of developing metabolic syndrome (MS) after kidney transplantation, which contributes to long-term cardiovascular (CV) morbidities and decline in allograft function. While MS in the general population occurs due to excess caloric intake and physical inactivity, additional chronic kidney disease and transplant-related factors contribute to the development of MS in transplant recipients. Despite its significant health consequences, the interplay of the individual components in CV morbidity in pediatric transplant recipients is not well understood. Additionally, the optimal methods to detect early CV dysfunction are not well defined in this unique population. The quest to establish clear guidelines for diagnosis is further complicated by genetic differences among ethnic groups that necessitate the development of race-specific criteria, particularly with regard to individuals of African descent who carry the apolipoprotein L1 variant. In children, since major CV events are rare and traditional echocardiographic measures of systolic function, such as ejection fraction, are typically well preserved, the presence of CV disease often goes undetected in the early stages. Recently, new noninvasive imaging techniques have become available that offer the opportunity for early detection. Carotid intima-media thickness and impaired myocardial strain detected by speckle tracking echocardiography or cardiac magnetic resonance are emerging as early and sensitive markers of subclinical CV dysfunction. These highly sensitive tools may offer the opportunity to elucidate subtle CV effects of MS in children after transplantation. Current knowledge and future directions are explored in this review.

Comments

Reproduced with permission of Oxford University Press. Clinical Kidney Journal

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Peer Reviewed

1

Open Access

1

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