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Kidney Week

Abstract: FR-PO1138

Effect of Elevated Systolic Blood Pressure and Pulse Pressure on the Progression of CKD in Children

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Raina, Rupesh, Cleveland Clinic Akron General, Broadview Heights, Ohio, United States
  • Krishnappa, Vinod, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, United States
  • Polaconda, Shyam sunder R., Akron Nephrology Associates, Akron, Ohio, United States
  • Kapur, Gaurav, Children's Hospital of Michigan, Detroit, Michigan, United States
  • Kusumi, Kirsten, Akron Children''s Hospital, Akron, Ohio, United States
  • Mhanna, Maroun, Metrohealth Medical Center, Cleveland, Ohio, United States
Background

Increased systolic blood pressure (SBP) and pulse pressure (PP) are associated with the progression of chronic kidney disease (CKD) and there is a good correlation between increased left ventricular mass index (LVMI) and decline in glomerular filtration rate (GFR). However, the exact nature of the relationship between PP, SBP, and LVMI has not been established in children with CKD, which this study aims to investigate.

Methods

This is a retrospective study of pediatric patients with CKD utilizing Chronic Kidney Disease in Children (CKiD) database from the National Institute of Diabetes and Digestive Kidney Disease (NIDDK) registry. Only children with iohexol-based GFR (iGFR) < 60 ml/min/1.73 m2(n=620) were included for analysis. Analysis of relationships between SBP vs iGFR, diastolic blood pressure (DBP) vs iGFR, PP vs iGFR and LVMI vs iGFR were done using a two-tailed significance test and Pearson’s correlation coefficient. Statistical analysis was done using SPSS software.

Results

The clinical characteristics at baseline were age 9.8 ± 4.4 years (mean ± SD), iGFR 37.9 ± 12.1 ml/min/1.73 m2, SBP 107.9 ± 13.5 mm Hg, DBP 66.3 ± 11.4 mm Hg, PP 41.7 ± 10.8 mm Hg, and LVMI 30.9 ± 9.3. Increasing SBP and PP strongly correlated with decreasing iGFR (r=-0.16, p<0.001 and r=-0.08, p<0.003) (Figures 1 & 2). Increasing DBP also correlated well with decreasing iGFR (r=-0.11, p<0.01). This inverse relationship was also maintained between LVMI and iGFR (r=-0.09, p<0.05). No significant association found between PP and LVMI (r = 0.037; p = 0.334).

Conclusion

A strong inverse relationship exists between iGFR and LVMI, SBP, DBP, PP. These findings suggest that effective blood pressure control is of paramount importance in CKD children to decrease the rate of decline in renal function.

Figure 1 & 2. Relationship between iohexol-based GFR (iGFR)with systolic blood pressure and pulse pressure in children with chronic kidney disease