Children with renal diseases suffer from damage to the vessels and the heart that is normally found in much older individuals. The risk of death from a heart attack or a stroke for young adults with renal disease is up to 1000-fold higher compared with healthy population. To date, little is known about the factors that promote or hinder the development of these detrimental vascular and cardiac changes as well as on the natural cause of these changes. In accordance, the best treatment for prevention of these vascular and cardiac diseases is not known. It has been suspected that once renal failure has progressed to end-stage renal disease, immediate renal transplantation without intermittent renal replacement therapy by dialysis (ie. preemptive transplantation) is superior with regard to the vascular and cardiac changes. Therefore, the aim of the study is to evaluate 1) whether renal transplantation can stop vascular and cardiac changes or even reverse them, and 2) whether preemptive renal transplantation is superior to transplantation after some time on dialysis.

The investigator-initiated 4C (cardiovascular comorbidity in children with chronic kidney disease) study examines vascular and cardiac changes in children with renal disease. The proposed 4C transplantation study examines the effect of transplantation on cardiovascular comorbidity. We will measure markers of vascular and cardiac damage in 100 transplanted children before and over three years after transplantation: 1) thickness of the inner and middle layer of the carotid artery (intima media thickness, IMT), 2) speed of the pulse wave as it travels through the human body (pulse wave velocity, PWV), and 3) weight of the cardiac muscle (left ventricular mass index, LVMI). Early changes in these parameters, all of which can non-invasively be assessed, may predict a negative outcome in the future. By evaluating the effect of transplantation on these parameters we will assess the effect of transplantation on patient outcomes.