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Kidney Week

Abstract: FR-PO1062

Relationship Between 24-Hour Blood Pressure (BP) Load and Renal or Cardiac Outcomes in Children with CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Lee, Jason T., University of California San Francisco, San Francisco, California, United States
  • Seth, Divya, University of California San Francisco, San Francisco, California, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Samuels, Joshua A., University of Texas, Houston, Texas, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Blood pressure (BP) load, the proportion of elevated BPs detected by 24h ambulatory blood pressure monitoring (ABPM), is not a uniform criteria for diagnosing hypertension in all BP guidelines. We aimed to determine whether systolic BP load on ABPM was associated with adverse renal or cardiac outcomes in children with chronic kidney disease (CKD).

Methods

We analyzed data from 533 children with CKD. We categorized the BP status of participants as normotensive (normal mean awake/sleep BP and normal BPL), isolated BPL elevation (normal mean awake/sleep BP, elevated BPL >25%), or hypertensive (elevated mean awake/sleep BP, regardless of BP load). We examined the association between BP status and left ventricular hypertrophy (LVH) in logistic models and ESRD in Cox models. We also examined the value of considering BPL (as a continuous variable) independently and in conjunction with mean BP in predicting outcomes. We tested for differences in risk discrimination in our models (using c-statistics).

Results

One-third of the cohort met criteria for ambulatory hypertension and an additional 25% of participants had isolated BPL elevation. In both unadjusted and adjusted analyses, isolated BPL elevation was not statistically significantly associated with LVH or ESRD compared to those with normotension, whereas hypertension was (figure). Although BPL was independently associated with risk of ESRD, when used in conjunction with mean BPs, BPL was no longer associated with outcomes [table]. BPL also provided poor risk discrimination for LVH and ESRD [table].

Conclusion

BPL may not provide additive prognostic information over and beyond mean BP, and isolated BPL elevations were not associated with risk of LVH or ESRD in children with CKD.

Funding

  • NIDDK Support