Abstract: FR-PO464
Elevated Time-Varying BP Is Associated with Greater Risk of Progression of CKD Than Elevated Baseline BP in Children with Non-Glomerular CKD
Session Information
- CKD: Risk Factors for Incidence and Progression - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 301 CKD: Risk Factors for Incidence and Progression
Authors
- Reynolds, Ben C, Royal Hospital for Children, Glasgow, Glasgow, United Kingdom
- Roem, Jennifer, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, United States
- Pierce, Christopher B., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
- Matsuda-Abedini, Mina, The Hospital for Sick Children, Toronto, Toronto, Ontario, Canada
- 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
- Parekh, Rulan S., The Hospital For Sick Children, Toronto, Ontario, Canada
Background
Effective treatment of hypertension in children with chronic kidney disease (CKD) slows the rate of progression to end stage renal disease (ESRD). Less clear is whether longitudinal (e.g. annual time varying) measures of blood pressure (BP) are associated with greater risk of progression. We quantified this risk with systolic or diastolic casual BP measurement > 90th centile at baseline or longitudinally in children with CKD.
Methods
Of 826 children (257 glomerular disease,569 non-glomerular) enrolled in the CKiD cohort, we determined if BP <50th, 50th-90th, or >90th centile (for age, gender and height) was associated with a composite outcome of CKD progression: ESRD or GFR reduction of 50% from baseline. BP category was defined as time-fixed (baseline) and time-varying (last available). Pooled logistic models using inverse probability weighting were used to estimate the relative hazard odds of progression associated with each BP category and stratified by CKD diagnosis.
Results
Higher SBP percentile was associated with an elevated risk of progression, the time-varying metric estimating a higher magnitude of risk compared to time-fixed baseline measures (Table). Adjustment for potential confounders did not qualitatively change the risk in non-glomerular disease but nullified the estimate in glomerular disease.
Conclusion
Elevated time-varying systolic BP is associated with a greater risk of CKD progression than baseline BP in children with non-glomerular CKD. Clinicians can use updated BP to assess risk for progressive CKD and adjust management accordingly.
Table: Hazard Odds Ratio (95% confidence intervals)
| Unadjusted | Adjusted | ||||
| Non-glomerular | Glomerular | Non-glomerular | Glomerular | ||
| Baseline SBP % | <50th | ref | |||
| 50-90th | 1.07 (0.76,1,52) | 1.63 (0.96, 2.79) | 1.15 (0.81,1.63) | 1.14 (0.69, 1.89) | |
| >90th | 1.67 (1.12, 2.47) | 3.39 (1.91, 6.02) | 1.79 (1.2,2.68) | 1.34 (0.75,2.4) | |
| Time-varying SBP % | <50th | ref | |||
| 50-90th | 1.59 (1.12, 2.27) | 1.79 (1.05,3.07) | 2.55 (1.64,3.97) | 0.86 (0.42,1.79) | |
| >90th | 3.35 (2.25,5) | 4.48 (2.53,7.95) | 3.16 (1.82,5.5) | 0.85 (0.35,2.02) | |
| Baseline DBP % | <50th | ref | |||
| 50-90th | 1.15 (0.8, 1.64) | 1.28 (0.72,2.2) | 1.17 (0.82,1.67) | 1.02 (0.62,1.69) | |
| >90th | 1.19 (0.77,1.85) | 4.71 (2.6,8.52) | 1.23 (0.79,1.91) | 2.68 (1.42,5.07) | |
| Time-varying DBP % | <50th | ref | |||
| 50-90th | 1.39 (0.98,1.96) | 0.93 (0.53,1.63) | 1.78 (1.15,2.76) | 0.46 (0.22,0.94) | |
| >90th | 1.81 (1.18,2.79) | 5.28 (3.04,9.17) | 1.64 (0.89,3.01) | 1.45 (0.66,3.2) | |
* adjusted for GFR, proteinuria, antihypertensive use, immunosuppressant use (G only), age, male sex, black race, BMI z-score
Funding
- NIDDK Support