Evaluation of Angiopoietin-2 Serum Level as a Marker of Cardiovascular Risk in Children with Chronic Kidney Disease

Abstract

Background: Cardiovascular complications are a major clinical problem in uremic patients accounting for 44% of all deaths in this population. Angiopoietin cytokines are involved with controlling micro vascular permeability, vasodilatation and vasoconstriction by signaling smooth muscle cells surrounding vessels. Aim: To assess Angiopoietin-2 serum level as an early marker of cardiovascular risks in children with chronic kidney disease on regular hemodialysis and correlate with intimal medial thickness and echo data in those children. Patients and methods: The study included 40 children with CKD on regular hemodialysis (HD), and they were selected from the hemodialysis unit of Al-Zahraa Hospital, Al-Azhar University, during the period from December 2014 to April 2015. Another group of 40 apparently healthy children, matches age and sex with patients group as a controls. Angiopoietin-2 serum level, Doppler ultrasound (U/S) to assess: intima-media thickness (IMT) and the peak systolic velocity (PSV) of the main arteries including the (aorta, carotid and femoral) arteries, conventional echo and tissue Doppler imaging (TDI) of mitral and tricuspid annular velocities are obtained for both groups. Results: Children on regular HD have significantly higher (Angiopoietin-2) serum level compared to their controls, and it is (161.35 ± 38.30 ng/ml) and (9.25 ± 12.64 ng/ml) respectively ( p , 0.000) and increases in the aorta, carotid and femoral (IMT) with significant increase in their mean systolic velocities in patients group compared to the controls. Significant increase in tricuspid valve late diastolic velocity (TVA vel m/s) and (E/e’ ratio) obtained by (TDI), its abnormalities threshold is detected in patients group than controls, with significant increase right ventricular systolic pulmonary pressure in patients compared to the controls. Conclusions: Higher prevalence of right ventricular dysfunction is detected by conventional and TDI echo in children on hemodialysis. Angiopoietin-2 can be used as an ideal biomarker which may progress to play an adjunctive role with echocardiography in assessing cardiovascular risk of children with CKD on regular hemodialysis.