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Abstract: TH-PO769

Longitudinal Associations Between Vitamin D and Blood Pressure in the CKD in the Children (CKiD) Cohort

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Kumar, Juhi, Weill Cornell Medical College, New York, New York, United States
  • Roem, Jennifer, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 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
  • Atkinson, Meredith A., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
Background

Preclinical studies suggest that 25 hydroxy vitamin D (25OHD) modulates the renin-angiotensin-aldosterone system, vascular smooth muscle cells and the endothelium. Analysis of data from the “Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of CKD in Pediatric Patients” study showed that subjects with 25OHD levels <20 ng/ml had a higher diastolic BP than those with levels ≥20 ng/ml (p=0.004). Children with 25OHD levels < 20 ng/ml in the CKiD cohort had SBP 0.29 standard deviations higher (95%CI: 0.07, 0.51, p=0.009) at baseline.

Methods

Longitudinal associations between hypertension (SBP or DBP ≥95th percentile) and baseline 25OHD (deficiency < 20 ng/ml) and 1,25(OH)2D (per 10 pg/ml) levels), adjusted for baseline covariates, were examined using mixed-effects logistic regression that included a random subject effect to account for repeated measurements of the outcome within each subject. Covariates included were age, gender, race, years from visit 2, CKD etiology, BMI, GFR, proteinuria and medications used (antihypertensive, steroids, active and inactive vitamin D supplements). Study population included 536 subjects contributing 2741 visits (subset of n=365 with available ABPM measurements at visit 2 contributing 803 visits).

Results

Participants with 25OHD deficiency had greater odds of having systolic (OR 1.80, 95%CI: 1.22, 2.65; p=0.003) as well as casual hypertension (OR: 1.48, 95% CI: 1.04, 2.11, p=0.03). Male gender decreased the odds of hypertension. Higher BMI, nephrotic range proteinuria and active vitamin D use were associated with higher odds of systolic hypertension (Table 1). 1,25(OH)2D was significantly associated with hypertension (OR= 0.81, 95%CI: 0.70, 0.95) in univariate analysis only. Neither vitamin D measures were associated with ABPM hypertension.

Conclusion

25OHD deficiency is associated with higher odds of persistent casual hypertension. It may be beneficial to maintain 25OHD levels >20 ng/ml to optimize BP control in children with CKD.

Funding

  • NIDDK Support