Objective: To analyze the late cardiovascular outcome of end-stage renal disease (ESRD) in children.
Design: A nation-wide long-term follow-up study. Determinants of outcomes and causes of death were retrospectively assessed. Patients underwent assessment of overall health state, B- and M-mode ultrasound of the carotid arteries, and echocardiography for cross-sectional analysis.
Results: We analyzed the medical course of all 249 adult Dutch patients with ESRD onset between 1972 and 1992 at age 0 - 14 years, and who were born before 1979. Of the 187 living patients, 140 participated in the cross-sectional part of the study. The standardized mortality rate was 31.0. Overall 5-, 10-, and 20-year survival after ESRD onset was 87%, 82%, and 78%, respectively. Cardiovascular disease accounted for most deaths (41%). In the whole group, left ventricular hypertrophy (LVH), aortic valve calcification, and arterial wall stiffening were highly prevalent. LVH was associated with hypertension at time of assessment. Aortic valve calcification was strongly associated with a long total duration of peritoneal dialysis (beta = 0.33, p < 0.001). Arterial wall pathology was not associated with current treatment modality.
Conclusions: As in adults, cardiovascular disease is the most important cause of death in children with ESRD. Stricter reduction of volume overload, prevention of high serum calcium-phosphate product, and more vigorous treatment of hypertension are important targets to improve cardiovascular survival in children with ESRD.