Kidney Week

Abstract: TH-OR098

Aortic Stiffness Index by Echocardiography: An Early Clinical Marker of Vascular Stiffness in Pediatric Patients with CKD

Session Information

• Shaping Pediatric Kidney Disease: Developmental Insights, Stem Cell Systems, Novel Biomarkers, and More
  October 22, 2026 | Location: Room 603, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Vidi, Smitha R., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Smitha R. Vidi, MD, MS, FASN

• Matheson, Matthew, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Matthew Matheson

• Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Mark Mitsnefes, MD, MS

Background

Chronic Kidney Disease (CKD) causes accelerated vascular aging. Arterial stiffness is associated with hypertension (HTN), future cardiovascular (CV) events and is surrogate marker of CV disease in adults. Risk factors for arterial stiffness in early pediatric CKD and its CV implications are not known. We aimed to determine the risk factors for elevated Arterial Stiffness Index (ASI) measured by echocardiogram.

Methods

We studied children 5 to <18 years with CKD (U25 eGFR 30-90 ml/min/1.73m²) with no CV disease with one or more ASI measurements using data from the Chronic Kidney Disease in children (CKiD) cohort. We evaluated the association between demographic factors, biomarkers and HTN status (AAP 2017 guidelines) and ASI in all children and in children not on anti-HTN medications. Generalized estimating equations were used to account for repeated measures in our analyses.

Results

Out of 1100 participants in the CKiD study, 797 (61% males, 20% glomerular disease, non-HUS), median age of 11.9 [IQR: 7.8,15.8] yrs, and median GFR of 49 [IQR: 35, 64] ml/min/1.73m²) had one or more ASI measurements (n=1568). Sixty three percent were on anti-HTN medications; 24% had casual HTN and 12% had elevated BP. A total of 497 subjects (n=779 echo studies) had both casual and ABPM measurements and were included in the risk factor analysis. Male gender (β =+9.6%, 95% CI [+1.3%, +18.6%]) and isolated systolic HTN (β =+17.6%, 95% CI [+1.6%, +36.3%]) were associated with higher ASI in a fully adjusted model. Analysis of 195 children not on anti-HTN medications (n=279 echo studies) showed elevated BMI (β =+9.5%, 95% CI [+3.7%, +15.6%]) and male gender (β =+18.1%, 95% CI [+4.6%, +33.5%]) were associated with higher ASI in a fully adjusted model. Lower diastolic BP and higher pulse pressure (PP) were also associated with higher ASI in children, including among those without anti-HTN medications.

Conclusion

Male gender and elevated BMI are risk factors for elevated ASI in early pediatric CKD. Isolated systolic HTN, low diastolic BP and higher PP were found to be associated with elevated ASI in this population. Elevated ASI and its association with high PP indicate that ASI by echo may be an early clinical marker for arterial stiffness and early vascular aging in children with CKD.

Funding

• NIDDK Support