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Frequency and risk factors for arteriopathy in children and adolescents with end stage renal disease

Grant number: 11/24030-0
Support type:Regular Research Grants
Duration: December 01, 2012 - June 30, 2015
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Paulo Cesar Koch Nogueira
Grantee:Paulo Cesar Koch Nogueira
Home Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil
Assoc. researchers:Heitor Pons Leite

Abstract

The treatment of end stage renal disease (ESRD) in children has evolved, thanks to advances in dialysis and kidney transplantation outcomes, achieving short-term mortality reduction and shifting the interest to medium and long-term medical complications. Currently cardio circulatory events stand out as the main cause of mortality in the long run, becoming the leading challenge in the treatment of patients with ESRD. There are published data from Europe and North America countries showing vascular calcification in children with ESRD but in a preliminary study carried out in our hospital involving 19 children who underwent kidney transplantation, we did not find vascular calcification in any patient, suggesting that this alteration may be less frequent in our environment. The hypothesis of the present research is that vascular changes, as calcification and intima-media wall thickening of the arteries, are already present at the time of renal transplantation in children and adolescents with ESRD but we do not know the frequency and extension of this process in our milieu. The objective of the study is to investigate the frequency of these arterial lesions and also the main risk factors for this outcome. We will carry out an observational prospective study with control group, involving 70 patients undergoing renal transplantation. A fragment of the inferior epigastric artery will be removed during surgery and subjected to pathologic examination to assess the presence of arterial calcification and intima-media thickening. In addition, within 15 days after the kidney transplant ultrasound assessment of intima-media thickness of carotid and echocardiogram will be performed. The presence of artery calcification or intima-media thickening, either in the pathology exam or in the ultrasound, will be the outcome variables and the risk factors potentially associated with these outcomes will be: etiology of CKD, dialysis and CKD duration, the use of exogenous active vitamin D and phosphate binders based on calcium, serum levels of uric acid, vitamin D, intact PTH, FGF-23 and Ca x P product. A control group involving 20 cases matched by gender and age among the deceased donors will be studied in order to compare the results of microscopic examination of the arteries. In these subjects a section of the renal artery will be studied. Another control group involving 20 children with no known diseases, matched by gender and age, will be studied in order to compare the ultrasound examinations of the carotid artery. (AU)

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
DE MENEZES, FERNANDA L.; KOCH-NOGUEIRA, PAULO C.; DO VAL, MARIA L. D. M.; PESTANA, JOSE O. M.; JORGETTI, VANDA; DOS REIS, MARLENE A.; DOS REIS MONTEIRO, MARIA L. G.; LEITE, HEITOR P. Is arterial calcification in children and adolescents with end-stage renal disease a rare finding?. NEPHROLOGY, v. 24, n. 7, p. 696-702, JUL 2019. Web of Science Citations: 0.
DO VAL, MARIA LUIZA; MENEZES, FERNANDA SOUZA; MASSAOKA, HENRIQUE TSUHA; SCAVARDA, VALESKA TAVARES; CZAPKOWSKI, ADRIANO; LEITE, HEITOR PONS; MOISES, VALDIR AMBROSIO; AJZEN, SERGIO ARON; DE ABREU CARVALHAES, JOAO TOMAS; MEDINA PESTANA, JOSE OSMAR; KOCH-NOGUEIRA, PAULO. Cardiovascular risk in children and adolescents with end stage renal disease. Clinics, v. 74, 2019. Web of Science Citations: 0.

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