Kidney Week

Abstract: TH-OR043

Central Blood Pressure and Measures of Vascular Health in Children with ADPKD

Session Information

• Featured Research in Pediatric Nephrology
  October 25, 2018 | Location: 26A, San Diego Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Winyard, Paul, UCL GOS Institute of Child Health, London, United Kingdom

Paul Winyard, MBChB, PhD

• Marlais, Matko, UCL GOS Institute of Child Health, London, United Kingdom

Matko Marlais,

• Gu, Haotian, King's College London, London, United Kingdom

Haotian Gu,

• Sinha, Manish, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

Manish Sinha,

Background

Hypertension is increasingly recognised in children with Autosomal dominant polycystic kidney disease (ADPKD) but underlying cardiovascular factors such as central blood pressure (cBP) and pulse wave velocity (PWV) may change before overt hypertension. We assessed peripheral BP (pBP), cBP, pulse pressure (PP) amplification ratio, carotid-femoral PWV (PWVcf) and indexed left ventricular mass (LVMI) in children with ADPKD.

Methods

This was a two-centre prospective observational study of children with ADPKD versus age and BMI-matched healthy controls. All children underwent manual pBP, cBP using radial applanation tonometry and PWVcf with a SphygmoCor device. LVMI was measured by 2D m-mode echocardiography. 24-hour ambulatory BP monitoring (ABPM) and urine albumin: creatinine ratio was assessed in children with ADPKD. Estimated GFR was calculated in children where blood tests were performed.

Results

47 ADPKD and 49 healthy controls (mean ages 11.4 and 11.7 years, 55% and 39% male respectively) were recruited from two paediatric nephrology centres. Children with ADPKD had significantly higher pBP (mean 112/65mmHg vs. 104/60mmHg, systolic p<0.001) and cBP (mean 97/67mmHg vs. 87/61mmHg, systolic p<0.001) compared to healthy children. There was no significant difference between clinic pBP and 24-hour ABPM. 9 children (19%) with ADPKD were on anti-hypertensive medication. Children with ADPKD had a significantly lower PP amplification ratio (1.59 vs. 1.67, p=0.04) compared to healthy children. There was no difference in PWVcf between affected and healthy children (mean 5.74m/s vs. 5.57m/s, p=0.46). Children with ADPKD had a significantly higher LVMI (mean 30.4 g/m^2.7 vs. 26.2 g/m^2.7, p=0.01), although only one had frank hypertrophy. There was significantly lower eGFR (mean 89.9ml/min/1.73m² vs. 101.4ml/min/1.73m², p<0.01) and 42% of children with ADPKD had evidence of microalbuminuria with a raised albumin:creatinine ratio.

Conclusion

This study confirmed that a significant percentage of children with ADPKD have higher blood pressure, with novel cardiovascular findings of normal PWV but significantly lower PP amplification and increased LVMI. These early cardiovascular abnormalities should be amenable to antihypertensive therapy, reinforcing the need for routine screening of children and young people with ADPKD. eGFR and microalbuminaria warrant checking at the same visit.