Pulse wave velocity in children following renal transplantation

Abstract

Background. Arterial stiffness (ASt) increases with age, a 
\nprocess accelerated by uraemia and reversed by transplantation 
\n(Tx). Increased ASt results in an elevated pulse wave velocity 
\n(PWV). Methods. To compare the PWV of Tx patients (n = 25, age = 
\n15.1/95% CI = 13.5-16.7/year) and healthy controls, three 
\ncontrol groups were formed: matched for age (A), for height and 
\nweight (H/W) and for age and height (A/H), respectively. To 
\navoid bias from the growth deficit of Tx, firstly Z-scores of 
\nPWV were calculated (PWV-Z). Second, the PWV/height (PWV/h) 
\nratio was assessed. Pre-Tx serum Ca, P, PTH and the cumulative 
\ndose of calcitriol (cCTL) were also analysed. Finally, Tx 
\npatients were compared to ESRD patients (n = 11). PWV was 
\nmeasured by applanation tonometry. Results. Tx were smaller than 
\nA and older than H/W. The PWV of Tx differed only from H/W and 
\nA/H. PWV-Z and PWV/h of Tx were increased compared to all 
\ncontrol groups. They correlated with the CaxP and cCTL before Tx 
\nand were independent of age. Patients with creatinine clearance 
\n> 90 ml/min/1.73 m(2) or < 1 year on dialysis had lower PWV-Z 
\nand PWV/h than ESRD. Conclusion. Controls that matched for both 
\nage and height should be used to assess PWV in children with 
\ngrowth failure. PWV-Z is a universal age-independent parameter 
\nof PWV in cases of growth retardation; PWV/h is a simple 
\nalternative of PWV-Z. CaxP and cCTL are major determinants of 
\nASt after Tx. PWV may be reduced after Tx suggesting that the 
\nuraemia-induced cardiovascular changes might be reversible.