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Abstract: FR-PO1063

Ambulatory Hypertension Disproportionately Affects African American Children with Non-Glomerular CKD Independent of Socioeconomic Factors

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Sgambat, Kl, Children's National Health System, DC, District of Columbia, United States
  • Roem, Jennifer, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Samuels, Joshua A., University of Texas, Houston, Texas, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Moudgil, Asha, Children's National Health System, DC, District of Columbia, United States
Background

Although hypertension is common in children with chronic kidney disease (CKD), particularly among African Americans (AA), the extent to which that association is explained by socioeconomic factors (SES) is not well known. The objective of this study was to contrast racial differences in ambulatory hypertension among children with CKD before and after adjustment for putative confounding SES factors.

Methods

This cross-sectional analysis comprised 1021 repeated measures from 475 children enrolled in the CKiD study, stratified by glomerular and non-glomerular diagnosis. Children (1-16 years, eGFR 30-90 ml/min/1.73m2 at study entry) with at least 1 ambulatory blood pressure monitor (ABPM) measurement were included. Logistic regression models were used to estimate odds ratios (OR) of ABPM hypertension (systolic or diastolic wake/sleep blood pressure >95th or load>25th percentile) associated with AA race. Inverse probability weighting was used to account for potential confounding of SES (public insurance, food insecurity, household income, maternal education), abnormal birth history, demographics (age, sex), obesity (BMI>95th percentile) and disease severity (eGFR<45 mL/min|1.73m2) at study entry.

Results

Overall prevalence of ambulatory hypertension was 54%. AA children with both glomerular and non-glomerular CKD were disproportionately affected by SES variables by univariate analysis. In unadjusted models, AA children with non-glomerular disease had higher odds of ambulatory hypertension (OR=2.93; 95%CI:1.57, 5.47, p=0.001). Multivariable analysis adjusted for demographics, SES, birth history, obesity, and disease severity showed that among the non-glomerular group, AA children had 3.08-fold odds (95%CI:1.58, 6.00, p=0.001) of ambulatory hypertension. However, there was no difference in ambulatory hypertension between AA and Caucasian children with glomerular CKD, either unadjusted (OR=1.54; 95%CI:0.73, 3.26, p=0.262) or adjusted (OR=1.26; 95%CI:0.40, 4.00, p=0.694).

Conclusion

AA children with non-glomerular CKD are disproportionately affected by ambulatory hypertension, independent of SES. Glomerular injury is a driving force of hypertension, thus minimizing racial differences in ambulatory hypertension after adjustment for SES in children with glomerular CKD.

Funding

  • NIDDK Support