Abstract: FR-PO543

Ambulatory Blood Pressure and CKD Progression in the CKiD Cohort

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes


  • Dionne, Janis M., BC Children's Hospital/ University of British Columbia, Vancouver, British Columbia, Canada
  • Jiang, Shuai, Johns Hopkins University, Baltimore, Maryland, United States
  • Ng, Derek, Johns Hopkins Bloomberg School of Public Health, 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
  • Samuels, Joshua A., University of Texas, Houston, Texas, United States

We evaluated mean arterial pressure (MAP) by ambulatory blood pressure monitoring (ABPM) in the CKiD cohort to investigate if low-normal MAP (<50th %ile) was associated with a decreased rate of CKD progression compared to conventional (50th-90th %ile) or high (>90th %ile) MAP.


The primary outcome was time to renal replacement therapy (RRT) or 50% decline in eGFR. The primary exposure was time-varying MAP. Analyses were stratified by glomerular and non-glomerular diagnosis. 3 Cox models were fit with conventional MAP as the reference: unadjusted; age, gender and race adjusted; + proteinuria adjusted.


190 children with glomerular and 489 with non-glomerular CKD contributed at least one ABPM study. Those with high MAP were more likely to be African American, had more proteinuria and were less likely to take ACEi/ARB. Among children with glomerular CKD, those with high MAP had a 2.49 higher hazard ratio (HR) for the outcome compared to conventional MAP (95%CI: 1.35, 4.57); the HR for low-normal MAP was protective (0.42, 95%CI: 0.15, 1.15) (Figure 1). The HR with non-glomerular CKD with high MAP was 1.76 (95%CI: 1.25, 2.47) and 0.71 (95%CI: 0.42, 1.21) for low-normal MAP. After adjusting for age, race, and gender results were similar. Adjustment for proteinuria reduced the effect size but not the direction of association or glomerular significance.


Ambulatory MAP >90th %ile was associated with a more rapid progression of CKD in children. The benefit of MAP <50th %ile was slightly reduced after adjustment for proteinuria. The prevalence of ACEi/ARB use was lower among those with high MAP indicating potential for benefit with therapy.


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