Ambulatory Blood Pressure and CKD Progression in the CKiD Cohort
November 03, 2017 | 10:00 AM - 10:00 AM
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Abstract: FR-PO543
Ambulatory Blood Pressure and CKD Progression in the CKiD Cohort
Session Information
Category: Hypertension
- 1106 Hypertension: Clinical and Translational - Secondary Causes
Authors
- 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
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Funding