Abstract: FR-PO542

Nocturnal Hypertension Is Common and Is Associated with CKD Progression in the Chronic Kidney Disease in Children Study (CKiD) Cohort

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Guzman- Limon, Monica L., McGovern Medical School at UTHealth, Houston, Texas, United States
  • Jiang, Shuai, Johns Hopkins University, Baltimore, Maryland, United States
  • Ng, Derek, Johns Hopkins University, Baltimore, Maryland, United States
  • Warady, Bradley A., The Children's Mercy Hospital, Kansas City, Missouri, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Samuels, Joshua A., McGovern Medical School at UTHealth, Houston, Texas, United States
Background

Hypertension (HT) affects nearly half of all of children with chronic kidney disease (CKD) and is a major modifiable cause of end organ disease. 24 hour ambulatory blood pressure monitoring (ABPM) has demonstrated the significance of nocturnal HT on CKD progression among adults. In children with CKD, the effect of nocturnal HT on CKD progression is unknown.

Methods

Stratified by CKD etiology, we investigated the relationships between daytime or nocturnal HT (or both), and a composite outcome (defined as RRT or a 50% decline in GFR) amonng CkiD participants using Cox proportional hazards models. Daytime and nocturnal HT were defined as: mean BP > 95th percentile and/or load > 25% for either systolic or diastolic BP within wake or sleep periods, respectively.

Results

1195 ABPM studies from 693 CKiD participants were reviewed. In 501 children with non-glomerular (NG) CKD, 40% were normotensive, 7% had daytime only HT, 19% had nocturnal only HT, and 34% had diurnal HT. In 192 children with glomerular (G) CKD, 44% were normotensive, 6% had daytime only HT, 20% had nocturnal only HT and 30% had diurnal HT. In models adjusting for age, gender and race, among NG children, presence of nocturnal only HT was significantly associated with outcome when compared to normotensive children (HR: 1.80, p=0.02). The presence of dirunal HT in this group had a more pronounced association (HR: 2.37, p<0.001). Among children with G CKD, the presence of nocturnal only HT or daytime only HT was not significantly associated with outcome (HR: 1.60, p=0.30 and HR: 1.31, p=0.67, respectively), while the presence of diurnal HT was strongly associated with outcome (HR: 4.38, p<0.001).

Conclusion

Nocturnal hypertension is associated with a significantly faster decline in kidney function (GFR decline or RRT) when compared to normotensive patients with CKD. This outcome is even more pronounced in patients with diurnal HT. This confirms the utility of ABPM in patients with CKD. Identifying and controlling both daytime and nocturnal HT using ABPM may improve outcomes and delay CKD progression in this population.

Funding

  • NIDDK Support