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  • Review Article
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Cardiovascular complications in children with chronic kidney disease

Nature Reviews Nephrology volume 7, pages 642–649 (2011)Cite this article

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Abstract

The lifespan of children with advanced chronic kidney disease (CKD) remains low compared with the general pediatric population. As in adults with CKD, cardiovascular disease accounts for the majority of deaths in children with CKD, as these patients have a high prevalence of traditional and uremia-related risk factors for cardiovascular disease. The cardiovascular adaptations that precipitate these terminal events begin in predialysis CKD. Initially, these alterations increase left ventricular performance and vascular function to maintain hemodynamic homeostasis. However, these modifications are unable to sustain cardiovascular function in the long term and ultimately lead to left ventricular failure, impaired cardiorespiratory fitness and even sudden death. In this Review, we provide an update on the prevalence of the risk factors associated with cardiovascular disease in pediatric patients with CKD, the cardiac and vascular adaptations that occur in these patients and the management of cardiovascular risk in this population.

Key Points

  • Cardiovascular disease is the major cause of death in young patients with childhood-onset chronic kidney disease (CKD)

  • Similar to adults with CKD, children with CKD have a high prevalence of traditional and CKD-related risk factors for cardiovascular disease

  • Cardiovascular abnormalities develop early in the course of CKD and progress as the end stage approaches

  • Left ventricular hypertrophy, increased carotid artery intima–media thickness and cardiac calcification are the most frequent early cardiovascular abnormalities in children with CKD

  • Pre-emptive kidney transplantation or intensified hemodialysis are key to the reduction of cardiovascular morbidity and mortality in children and young adults with CKD

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Figure 1: Cardiac adaptation in pediatric CKD.
Figure 2: Risk factors and adaptive mechanisms have been identified in patients with early CKD and accelerated vascular calcification who are on dialysis.

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References

  1. McDonald, S. P. & Craig, J. C. for the Australian and New Zealand Paediatric Nephrology Association. Long-term survival of children with end-stage renal disease. N. Engl. J. Med. 350, 2654–2662 (2004).

    Article  CAS  PubMed  Google Scholar 

  2. Groothoff, J. W. et al. Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int. 61, 621–629 (2002).

    Article  PubMed  Google Scholar 

  3. Chavers, B. M., Li, S., Collins, A. J. & Herzog, C. A. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 62, 648–653 (2002).

    Article  PubMed  Google Scholar 

  4. Parekh, R. S., Carroll, C. E., Wolfe, R. A. & Port, F. K. Cardiovascular mortality in children and young adults with end-stage kidney disease. J. Pediatr. 141, 191–197 (2002).

    Article  CAS  PubMed  Google Scholar 

  5. Mitsnefes, M. M. Cardiovascular complications of pediatric chronic kidney disease. Pediatr. Nephrol. 23, 27–39 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wilson, A. C. & Mitsnefes, M. M. Cardiovascular disease in CKD in children: update on risk factors, risk assessment, and management. Am. J. Kidney Dis. 54, 345–360 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hadstein, C. & Schaefer, F. Hypertension in children with chronic kidney disease: pathophysiology and management. Pediatr. Nephrol. 23, 363–371 (2008).

    Article  Google Scholar 

  8. Silverstein, D. M. Inflammation in chronic kidney disease: role in the progression of renal and cardiovascular disease. Pediatr. Nephrol. 24, 1445–1452 (2009).

    Article  PubMed  Google Scholar 

  9. Lilien, M. R. & Groothoff, J. W. Cardiovascular disease in children with CKD or ESRD. Nat. Rev. Nephrol. 5, 229–235 (2009).

    Article  CAS  PubMed  Google Scholar 

  10. Shroff, R., Quinlan, C. & Mitsnefes, M. M. Uraemic vasculopathy in children with chronic kidney disease: prevention or damage limitation? Pediatr. Nephrol. 26, 853–865 (2011).

    Article  PubMed  Google Scholar 

  11. Johnstone, L. M. et al. Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int. 50, 998–1006 (1996).

    Article  CAS  PubMed  Google Scholar 

  12. Mitsnefes, M. M. et al. Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J. Pediatr. 149, 671–675 (2006).

    Article  PubMed  Google Scholar 

  13. Glassock, R. J., Pecoits-Filho, R. & Barberato, S. H. Left ventricular mass in chronic kidney disease and ESRD. Clin. J. Am. Soc. Nephrol. 4 (Suppl. 1), S79–S91 (2009).

    Article  PubMed  Google Scholar 

  14. Mitsnefes, M. M. et al. Masked hypertension associates with left ventricular hypertrophy in children with CKD. J. Am. Soc. Nephrol. 21, 137–144 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ulinski, T., Genty, J., Viau, C., Tillous-Borde, I. & Deschênes, G. Reduction of left ventricular hypertrophy in children undergoing hemodialysis. Pediatr. Nephrol. 21, 1171–1178 (2006).

    Article  PubMed  Google Scholar 

  16. Mitsnefes, M. M. et al. Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors. Pediatr. Nephrol. 14, 898–902 (2000).

    Article  CAS  PubMed  Google Scholar 

  17. Bullington, N., Kartal, J., Khoury, P. & Mitsnefes, M. M. Left ventricular hypertrophy in pediatric kidney transplant recipients: long-term follow-up study. Pediatr. Transplant. 10, 811–815 (2006).

    Article  PubMed  Google Scholar 

  18. Wilson, A. C. et al. High prevalence of the metabolic syndrome and associated left ventricular hypertrophy in pediatric renal transplant recipients. Pediatr. Transplant. 14, 52–60 (2010).

    Article  PubMed  Google Scholar 

  19. Sinha, M. D. et al. Blood pressure control and left ventricular mass in children with chronic kidney disease. Clin. J. Am. Soc. Nephrol. 6, 543–551 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chinali, M. et al. Reduced systolic myocardial function in children with chronic renal insufficiency. J. Am. Soc. Nephrol. 18, 593–598 (2007).

    Article  PubMed  Google Scholar 

  21. Mitsnefes, M. M. et al. Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J. Am. Soc. Nephrol. 16, 2796–2803 (2005).

    Article  CAS  PubMed  Google Scholar 

  22. Weaver, D. J. Jr, Kimball, T. R., Koury, P. R. & Mitsnefes, M. M. Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease. Pediatr. Nephrol. 24, 565–570 (2009).

    Article  PubMed  Google Scholar 

  23. Raimondi, F. et al. Inappropriate left ventricular mass in children and young adults with chronic renal insufficiency. Pediatr. Nephrol. 24, 2015–2022 (2009).

    Article  PubMed  Google Scholar 

  24. Weaver, D. J. Jr et al. Subclinical systolic dysfunction in pediatric patients with chronic kidney disease. J. Pediatr. 153, 565–569 (2008).

    Article  PubMed  Google Scholar 

  25. Mitsnefes, M. M. et al. Left ventricular mass and systolic performance in pediatric patients with chronic renal failure. Circulation 107, 864–868 (2003).

    Article  PubMed  Google Scholar 

  26. Mese, T. et al. Contractility reserve in children undergoing dialysis by dobutamine stress echocardiography. Pediatr. Cardiol. 31, 937–943 (2010).

    Article  PubMed  Google Scholar 

  27. Hothi, D. K., Rees, L., Marek, J., Burton, J. & McIntyre, C. W. Pediatric myocardial stunning underscores the cardiac toxicity of conventional hemodialysis treatments. Clin. J. Am. Soc. Nephrol. 4, 790–797 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Mitsnefes, M. M. et al. Impaired left ventricular diastolic function in children with chronic renal failure. Kidney Int. 65, 1461–1466 (2004).

    Article  PubMed  Google Scholar 

  29. Weaver, D. J. Jr et al. Decreased maximal aerobic capacity in pediatric chronic kidney disease. J. Am. Soc. Nephrol. 19, 624–630 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shroff, R. C. & Shanahan, C. M. The vascular biology of calcification. Semin. Dial. 20, 103–109 (2007).

    Article  PubMed  Google Scholar 

  31. Shroff, R. C. et al. Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation 118, 1748–1757 (2008).

    Article  CAS  PubMed  Google Scholar 

  32. Blacher, J. et al. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int. 63, 1852–1860 (2003).

    Article  PubMed  Google Scholar 

  33. London, G. M. et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol. Dial. Transplant. 18, 1731–1740 (2003).

    Article  PubMed  Google Scholar 

  34. Civilibal, M. et al. Coronary artery calcifications in children with end-stage renal disease. Pediatr. Nephrol. 21, 1426–1433 (2006).

    Article  PubMed  Google Scholar 

  35. Goodman, W. G. et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N. Engl. J. Med. 342, 1478–1483 (2000).

    Article  CAS  PubMed  Google Scholar 

  36. Litwin, L. et al. Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J. Am. Soc. Nephrol. 16, 1494–1500 (2005).

    Article  PubMed  Google Scholar 

  37. Oh, J. et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106, 100–105 (2002).

    Article  PubMed  Google Scholar 

  38. Shroff, R. C. et al. Mineral metabolism and vascular damage in children on dialysis. J. Am. Soc. Nephrol. 18, 2996–3003 (2007).

    Article  CAS  PubMed  Google Scholar 

  39. Briese, S. et al. Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease-impact of calcium and vitamin D therapy. Nephrol. Dial. Transplant. 21, 1906–1914 (2006).

    Article  CAS  PubMed  Google Scholar 

  40. Civilibal, M. et al. Traditional and “new” cardiovascular risk markers and factors in pediatric dialysis patients. Pediatr. Nephrol. 22, 1021–1029 (2007).

    Article  PubMed  Google Scholar 

  41. Covic, A. et al. Increased arterial stiffness in children on haemodialysis. Nephrol. Dial. Transplant. 21, 729–735 (2006).

    Article  PubMed  Google Scholar 

  42. Srivaths, P. R., Silverstein, D. M., Leung, J., Krishnamurthy, R. & Goldstein, S. L. Malnutrition-inflammation-coronary calcification in pediatric patients receiving chronic hemodialysis. Hemodial. Int. 14, 263–269 (2010).

    Article  PubMed  Google Scholar 

  43. Shroff, R. et al. A bimodal association of vitamin D levels and vascular disease in children on dialysis. J. Am. Soc. Nephrol. 19, 1239–1246 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Zittermann, A., Schleithoff, S. S. & Koerfer, R. Putting cardiovascular disease and vitamin D insufficiency into perspective. Br. J. Nutr. 94, 483–492 (2005).

    Article  CAS  PubMed  Google Scholar 

  45. Ketteler, M. et al. Deficiencies of calcium-regulatory proteins in dialysis patients: a novel concept of cardiovascular calcification in uremia. Kidney Int. Suppl. 84, S84–S87 (2003).

    Article  CAS  Google Scholar 

  46. Shroff, R. C. et al. The circulating calcification inhibitors, fetuin-A and osteoprotegerin, but not matrix Gla protein, are associated with vascular stiffness and calcification in children on dialysis. Nephrol. Dial. Transplant. 23, 3263–3271 (2008).

    Article  CAS  PubMed  Google Scholar 

  47. van Summeren, M. J. et al. Circulating calcification inhibitors and vascular properties in children after renal transplantation. Pediatr. Nephrol. 6, 985–993 (2008).

    Article  Google Scholar 

  48. Shroff, R. C. et al. Chronic mineral dysregulation promotes vascular smooth muscle cell adaptation and extracellular matrix calcification. J. Am. Soc. Nephrol. 21, 103–112 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Johnson, K. L. Exercise in the end-stage renal disease population. J. Am. Soc. Nephrol. 18, 1845–1854 (2007).

    Article  CAS  Google Scholar 

  50. Painter, P., Krasnoff, J. & Mathias, R. Exercise capacity and physical fitness in pediatric dialysis and kidney transplant patients. Pediatr. Nephrol. 22, 1030–1039 (2007).

    Article  PubMed  Google Scholar 

  51. Goldstein, S. L. et al. Health-related quality of life in pediatric patients with ESRD. Pediatr. Nephrol. 21, 846–850 (2006).

    Article  PubMed  Google Scholar 

  52. Gerson, A. C. et al. Health-related quality of life of children with mild to moderate chronic kidney disease. Pediatrics 125, e349–e357 (2010).

    Article  PubMed  Google Scholar 

  53. Booher, M. A. & Smith, B. W. Physiological effects of exercise on the cardiopulmonary system. Clin. Sports Med. 22, 1–21 (2003).

    Article  PubMed  Google Scholar 

  54. Pattaragarn, A., Warady, B. A. & Sabath, R. J. Exercise in pediatric patients with end-stage renal disease. Perit. Dial. Int. 24, 274–280 (2004).

    PubMed  Google Scholar 

  55. Eijsermans, R. M., Creemers, D. G., Helders, P. J. & Schröder, C. H. Motor performance, exercise tolerance, and health-related quality of life in children on dialysis. Pediatr. Nephrol. 19, 1262–1266 (2004).

    Article  PubMed  Google Scholar 

  56. Tangeraas, T. et al. Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children. Pediatr. Nephrol. 25, 2343–2350 (2010).

    Article  PubMed  Google Scholar 

  57. Narayan, P. et al. Association of hemoglobin delivery with left ventricular structure and function in hypertensive patients: losartan intervention for end point reduction in hypertension study. Hypertension 47, 868–873 (2006).

    Article  CAS  PubMed  Google Scholar 

  58. Goldstein, S. L. & Montgomery, L. R. A pilot study of twice-weekly exercise during hemodialysis in children. Pediatr. Nephrol. 24, 833–839 (2009).

    Article  PubMed  Google Scholar 

  59. van Bergen, M. et al. Exercise training in pediatric patients with end-stage renal disease. Pediatr. Nephrol. 24, 619–622 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  60. ESCAPE Trial Group. Wühl, E. et al. Strict blood-pressure control and progression of renal failure in children. N. Engl. J. Med. 361, 1639–1650 (2009).

    Article  PubMed  Google Scholar 

  61. Fischbach, M., Dheu, C., Seuge, L., Menouer, S. & Terzic, J. In-center daily on-line hemodiafiltration: a 4-year experience in children. Clin. Nephrol. 69, 279–284 (2008).

    Article  CAS  PubMed  Google Scholar 

  62. Geary, D. F. et al. Home nocturnal hemodialysis in children. J. Pediatr. 147, 383–387 (2005).

    Article  PubMed  Google Scholar 

  63. Nesrallah, G., Sure, R., Moist, L., Kortas, C. & Lindsay, R. M. Volume control and blood pressure management in patients undergoing quotidian hemodialysis. Am. J. Kidney Dis. 42 (Suppl. 1), 13–17 (2003).

    Article  PubMed  Google Scholar 

  64. Fagugli, R. M. et al. Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients. Nephrol. Dial. Transplant. 18, 2332–2338 (2003).

    Article  PubMed  Google Scholar 

  65. Han, C. T., Floras, J. S., Miller, J. A., Richardson, R. M. & Pierratos, A. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int. 61, 2235–2239 (2002).

    Article  Google Scholar 

  66. The FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N. Engl. J. Med. 363, 2287–2300 (2010).

  67. Rees, L. What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence? Pediatr. Nephrol. 23, 179–184 (2008).

    Article  PubMed  Google Scholar 

  68. KDOQI Work Group. KDOQI clinical practice guidelines for nutrition in children with CKD: 2008 update. Executive summary. Am. J. Kidney Dis. 53 (3 Suppl. 2), S11–S104 (2003).

  69. Isakova, T. et al. Phosphorus binders and survival on hemodialysis. J. Am. Soc. Nephrol. 20, 388–396 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Rees, L. & Shroff, R. C. Phosphate binders in CKD: chalking out the differences. Pediatr. Nephrol. 25, 385–394 (2010).

    Article  PubMed  Google Scholar 

  71. Uhlig, K. et al. KDOQI US commentary on the 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD-Mineral and Bone Disorder (CKD-MBD). Am. J. Kidney Dis. 55, 773–799 (2010).

    Article  PubMed  Google Scholar 

  72. Pieper, A. K. et al. A randomized crossover trial comparing sevelamer with calcium acetate in children with CKD. Am. J. Kidney Dis. 47, 625–635 (2006).

    Article  CAS  PubMed  Google Scholar 

  73. Civilibal, M. et al. Progression of coronary calcification in pediatric chronic kidney disease stage 5. Pediatr. Nephrol. 24, 555–563 (2009).

    Article  PubMed  Google Scholar 

  74. Suki, W. N. et al. Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Kidney Int. 72, 1130–1137 (2007).

    Article  CAS  PubMed  Google Scholar 

  75. Drüeke, T. B. Treatment of secondary hyperparathyroidism of dialysis patients with calcimimetics as a valuable addition to established therapeutic means. Pediatr. Nephrol. 20, 399–403 (2005).

    Article  PubMed  Google Scholar 

  76. Geary, D. F., Hodson, E. M. & Craig, J. C. Interventions for bone disease in children with chronic kidney disease. Cochrane Database Syst. Rev. Issue 1. Art. No.: CD008327. doi:10.1002/14651858.CD008327 (2010).

  77. McKay, C. P & Portale, A. Emerging topics in pediatric bone and mineral disorders. Semin. Nephrol. 29, 370–378 (2009).

    Article  CAS  PubMed  Google Scholar 

  78. Schaefer, B. et al. Long-term control of parathyroid hormone and calcium-phosphate metabolism after parathyroidectomy in children with chronic kidney disease. Nephrol. Dial. Transplant. 25, 2590–2595 (2010).

    Article  CAS  PubMed  Google Scholar 

  79. VanDeVoorde, R. G. et al. Blood pressure control in pediatric hemodialysis: The Midwest Pediatric Nephrology Consortium Study. Pediatr. Nephrol. 22, 547–553 (2007).

    Article  PubMed  Google Scholar 

  80. Fadrowski, J. J. et al. Hemoglobin decline in children with chronic kidney disease: baseline results from the Chronic Kidney Disease in Children Prospective Cohort Study. Clin. J. Am. Soc. Nephrol. 3, 457–462 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Staples, A. O. et al. Anemia and risk of hospitalization in pediatric chronic kidney disease. Clin. J. Am. Soc. Nephrol. 4, 48–56 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  82. Warady, B. A. & Ho, M. Morbidity and mortality in children with anemia at initiation of dialysis. Pediatr. Nephrol. 18, 1055–1062 (2003).

    Article  PubMed  Google Scholar 

  83. Mitsnefes, M. M., Kartal, J., Khoury, P & Daniels, S. Adiponectin in children with chronic kidney disease: role of adiposity and kidney dysfunction. Clin. J. Am. Soc. Nephrol. 2, 46–50 (2007).

    Article  CAS  PubMed  Google Scholar 

  84. Flynn, J. T. et al. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study. Hypertension 52, 631–637 (2008).

    Article  CAS  PubMed  Google Scholar 

  85. Saland, J. M. et al. Dyslipidemia in children with chronic kidney disease. Kidney Int. 78, 1154–1163 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Saland, J. M., Ginsberg, H. & Fisher, E. Dyslipidemia in pediatric renal disease: epidemiology, pathophysiology, and management. Curr. Opin. Pediatr. 14, 197–204 (2003).

    Article  Google Scholar 

  87. Lai, H. L., Kartal, J. & Mitsnefes, M. M. Hyperinsulinemia in pediatric patients with chronic kidney disease: the role of tumor necrosis factor-α. Pediatr. Nephrol. 22, 1751–1756 (2007).

    Article  PubMed  Google Scholar 

  88. Mitsnefes, M. M. et al. Abnormal carotid artery structure and function in children and adolescents with successful renal transplantation. Circulation 110, 97–101 (2004).

    Article  PubMed  Google Scholar 

  89. Goldstein, S. L. et al. Acute and chronic inflammation in pediatric patients receiving hemodialysis. J. Pediatr. 143, 653–657 (2003).

    Article  CAS  PubMed  Google Scholar 

  90. Menon, S., Valentini, R. P., Hidalgo, G., Peschansky, L. & Mattoo, T. K. Vitamin D insufficiency and hyperparathyroidism in children with chronic kidney disease. Pediatr. Nephrol. 23, 1831–1836 (2008).

    Article  PubMed  Google Scholar 

  91. Rostand, S. G. & Drüeke, T. B. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int. 56, 383–392 (1999).

    Article  CAS  PubMed  Google Scholar 

  92. Merouani, A., Delvin, E. E., Genest, J. Jr, Rozen, R. & Lambert, M. Plasma homocysteine concentration changes after renal transplantation in children. Pediatr. Nephrol. 17, 520–523 (2002).

    Article  PubMed  Google Scholar 

  93. Merouani, A. et al. Plasma homocysteine concentration in children with chronic renal failure. Pediatr. Nephrol. 16, 805–811 (2001).

    Article  CAS  PubMed  Google Scholar 

  94. Feinstein, S. et al. Hyperhomocysteinemia in children on renal replacement therapy. Pediatr. Nephrol. 17, 515–519 (2002).

    Article  PubMed  Google Scholar 

  95. Omoloja, A. et al. Cigarette smoking and second-hand smoking exposure in adolescents with chronic kidney disease: a study from the Midwest Pediatric Nephrology Consortium. Nephrol. Dial. Transplant. 26, 908–913 (2011).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Nephrology Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK

    Rukshana Shroff

  2. Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center, 1001 Blythe Boulevard, Charlotte, 28232, NC, USA

    Donald J. Weaver Jr

  3. Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC 7022, 3333 Burnett Avenue, Cincinnati, 45229, OH, USA

    Mark M. Mitsnefes

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All authors contributed equally to all aspects of this Review.

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Correspondence to Mark M. Mitsnefes.

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Shroff, R., Weaver, D. & Mitsnefes, M. Cardiovascular complications in children with chronic kidney disease. Nat Rev Nephrol 7, 642–649 (2011). https://doi.org/10.1038/nrneph.2011.116

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