Metabolic Syndrome in Pediatric Patients with Chronic Kidney Disease

Chronic kidney disease (CKD) in children is a significant public health concern with long-term consequences, particularly due to cardiovascular complications, which are the leading cause of morbidity and mortality in early adulthood. The elevated cardiovascular risk in this population is driven by both traditional factors – such as hypertension, dyslipidemia, obesity, and metabolic syndrome – and nontraditional factors, including chronic inflammation, oxidative stress, vitamin D deficiency, disturbances in bone mineral metabolism, persistent proteinuria, and dysregulated adipocytokine secretion. The pathophysiology is complex and begins in the early stages of CKD, marked by endothelial dysfunction, vascular calcification, and ventricular remodeling. Visceral adiposity, hyperleptinemia, and adiponectin resistance contribute significantly to systemic inflammation and the progression of cardiovascular risk, from left ventricular hypertrophy and arterial stiffness to major cardiovascular events. Early intervention is essential, with a focus on nonpharmacological strategies. Key measures include proper nutrition, weight management, sodium and phosphorus restriction, and regular physical activity. Pharmacological treatments – such as renin–angiotensin–aldosterone system inhibitors, statins, and vitamin D supplementation – should be considered in selected cases, always within a comprehensive and individualized care plan.