Abstract: FR-PO545

Ambulatory (ABP) Hypertension (HT) Over Time Is Associated with Subsequent GFR Decline in Children with CKD

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Samuels, Joshua A., McGovern Medical School at UTHealth, Houston, Texas, United States
  • Ng, Derek, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Jiang, Shuai, Johns Hopkins University, Baltimore, Maryland, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Warady, Bradley A., The Children's Mercy Hospital, Kansas City, Missouri, United States
  • Dionne, Janis M., BC Children's Hospital/ University of British Columbia, Vancouver, British Columbia, Canada
Background

Ambulatory HT is associated with CKD stage. Longitudinal changes in ambulatory blood pressure (ABP) and their relationship to subsequent pediatric CKD progression is poorly described. We characterize changes in ABP and GFR over time in children in the CKiD cohort.

Methods

BP based on ABP and HT defined by CKiD ABP criteria. HT status could change following repeat ABPM (every other year) and thus exposure varied over time. We quantified transitions from normotensive (NT) to HT, as well as the risk of progression to composite endpoint (RRT or 50% drop in GFR) by relative hazards (HR) using Cox proportional hazards models. Analyses adjusted for age, gender, and race and stratified by CKD diagnosis (i.e., glomerular (G=501) or non-glomerular (NG=192) etiology).

Results

A change in BP category was common. For G, 56% had HT at entry; 16% transitioned to a NT during ~6 years follow up. Of those with NT at entry, 20% transitioned to HT. For NG, 60% had HT at entry and 24% transitioned to NT. Among the 40% with NT at entry, 38% transitioned to HT. CKD progression was significantly greater during periods of HT compared to NT. Figure 1 displays the incidence of composite endpoint (GFR decline or RRT) by ABP status (HT= red; NT=blue) for G and NG CKD. Differences were significant by ABP (log rank p< 0.001 for both groups): HT was associated with 2.81 times higher hazard of endpoint among children with G (95%CI: 1.51, 5.24) and a 2.09 times higher hazard among those with NG CKD (95%CI: 1.46, 2.99) in adjusted models. HRs remained significant when adjusted for proteinuria.

Conclusion

Ambulatory HT is common (~58%) in children with CKD. NT transitioned to HT more than vice versa in both G and NG children. Ambulatory HT was strongly associated with CKD progression.

Funding

  • NIDDK Support