The cardiovascular comorbidity in children with chronic kidney disease (4C) study: Objectives, design, and methodology

Uwe Querfeld, Ali Anarat, Aysun K. Bayazit, Aysin S. Bakkaloglu, Yelda Bilginer, Salim Caliskan, Mahmut Civilibal, Anke Doyon, Ali Duzova, Daniela Kracht, Mieczyslaw Litwin, Anette Melk, Sevgi Mir, Betül Sözeri, Rukshana Shroff, René Zeller, Elke Wühl, Franz Schaefer, L. B. Zimmerhackl, K. ArbeiterJ. Vande Walle, J. Dusek, P. Cochat, M. Fischbach, U. Querfeld, J. Dötsch, R. Büscher, M. Pohl, A. Melk, M. Kemper, F. Schaefer, E. Wühl, U. John, B. Hoppe, S. Wygoda, M. Konrad, G. Klaus, M. Wigger, P. Sallay, G. Montini, A. Canepa, S. Testa, L. Murer, C. M. Matteucci, L. Peruzzi, A. Jankauskiene, D. Drozdz, M. Litwin, A. Niemirska, T. Urasinski, A. M. Zurowska, A. Caldas-Afonso, A. Peco-Antic, R. Krmar, G. Laube, G. Simonetti, A. Anarat, A. S. Bakkaloglu, F. Yalcinkaya, E. Baskin, N. Cakar, O. Soylemezoglu, G. Demircin, S. Caliskan, N. Canpolat, N. Yildiz, M. Civilibal, A. Kiyak, H. Alpay, G. Ozcelik, S. Emre, S. Mir, R. Shroff

Research output: Contribution to journalArticlepeer-review


Background and objectives: Children and adolescents with chronic kidney disease (CKD) are at high risk for cardiovascular morbidity and mortality. A systemic arteriopathy and cardiomyopathy has been characterized in pediatric dialysis patients by the presence of morphologic and functional abnormalities. Design, setting, participants, & measurements: The Cardiovascular Comorbidity in Children with CKD (4C) Study is a multicenter, prospective, observational study aiming to recruit more than 600 children, aged 6 to 17 years, with initial GFR of 10 to 45 ml/min per 1.73 m2. The prevalence, degree, and progression of cardiovascular comorbidity as well as its association with CKD progression will be explored through longitudinal follow-up. The morphology and function of the heart and large arteries will be monitored by sensitive noninvasive methods and compared with aged-matched healthy controls. Multiple clinical, anthropometric, biochemical, and pharmacologic risk factors will be monitored prospectively and related to the cardiovascular status. A whole-genome association study will be performed to identify common genetic variants associated with progression of cardiovascular alterations and/or renal failure. Monitoring will be continued as patients reach end-stage renal disease and undergo different renal replacement therapies. Results: While cardiovascular morbidity in adults is related to older age and additional risk factor load (e.g., diabetes), the role of CKD-specific factors in the initiation and progression of cardiac and vascular disease are likely to be characterized with greater sensitivity in the pediatric age group. Conclusions: The 4C study is expected to provide innovative insight into cardiovascular and renal disease progression in CKD.

Original languageEnglish
Pages (from-to)1642-1648
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number9
Publication statusPublished - Sep 1 2010

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine


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