Browsing by Author "Querfeld, Uwe"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Dyslipidemia After Pediatric Renal Transplantation-The Impact of Immunosuppressive Regimens
    (2017) Habbig, Sandra; Volland, Ruth; Krupka, Kai Kai; Querfeld, Uwe; Dello Strologo, Luca; Yalcinkaya, Fatos; Noyan, Aytul; Topaloglu, Rezan; Webb, Nicholas J. A.; Kemper, Markus J.; Pape, Lars; Bald, Martin; Kranz, Birgitta; Taylan, Christina; Hoecker, Britta; Toenshoff, Burkhard; Weber, Lutz T.; 28370750; AAD-5713-2021
    Dyslipidemia contributes to cardiovascular morbidity and mortality in pediatric transplant recipients. Data on prevalence and risk factors in pediatric cohorts are, however, scarce. We therefore determined the prevalence of dyslipidemia in 386 pediatric renal transplant recipients enrolled in the CERTAIN registry. Data were obtained before and during the first year after RTx to analyze possible non-modifiable and modifiable risk factors. The prevalence of dyslipidemia was 95% before engraftment and 88% at 1year post-transplant. Low estimated glomerular filtration rate at 1year post-transplant was associated with elevated serum triglyceride levels. The use of TAC and of MPA was associated with significantly lower concentrations of all lipid parameters compared to regimens containing CsA and mTORi. Immunosuppressive regimens consisting of CsA, MPA, and steroids as well as of CsA, mTORi, and steroids were associated with a three- and 25-fold (P<.001) increased risk of having more than one pathologic lipid parameter as compared to the use of TAC, MPA, and steroids. Thus, amelioration of the cardiovascular risk profile after pediatric RTx may be attained by adaption of the immunosuppressive regimen according to the individual risk profile.
  • No Thumbnail Available
    Item
    Early Effects of Renal Replacement Therapy on Cardiovascular Comorbidity in Children With End-Stage Kidney Disease: Findings From the 4C-T Study
    (2018) Schmidt, Bernhard M. W.; Sugianto, Rizky Indrameikha; Thurn, Daniela; Azukaitis, Karolis; Bayazit, Aysun K.; Canpolat, Nur; Eroglu, Ayse Guler; Caliskan, Salim; Doyon, Anke; Duzova, Ali; Karagoz, Tevfik; Anarat, Ali; Deveci, Murat; Mir, Sevgi; Ranchin, Bruno; Shroff, Rukshana; Baskin, Esra; Litwin, Mieczyslaw; Ozcakar, Z. Birsin; Buscher, Rainer; Soylemezoglu, Oguz; Dusek, Jiri; Kemper, Markus J.; Matteucci, Maria C.; Habbig, Sandra; Laube, Guido; Wuehl, Elke; Querfeld, Uwe; Sander, Anja; Schaefer, Franz; Melk, Anette; https://orcid.org/0000-0002-3316-8032; 28926375; B-5785-2018
    Background The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. Methods We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). Results RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ss = -0.67; P < 0.001) and intima media thickness (ss = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ss = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ss = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ss = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ss = 1.47; P = 0.01). Conclusions In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.