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Abstract: PO2324

Proteinuria and Dipping on 24-Hour Ambulatory Blood Pressure Monitoring in Children

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Bakhoum, Christine Y., Rady Children's Hospital San Diego, San Diego, California, United States
  • Vuong, Kimmy Thien, Rady Children's Hospital San Diego, San Diego, California, United States
  • Carter, Caitlin E., Rady Children's Hospital San Diego, San Diego, California, United States
  • Garimella, Pranav S., University of California San Diego, La Jolla, California, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
Background

Absence of nocturnal blood pressure dipping is associated with adverse cardiovascular outcomes in adults. Risk factors for non-dipping in adults include obesity and proteinuria. In children, risk factors for non-dipping have not been well established.

Methods

We identified consecutive patients aged 5 to 19 years who underwent 24-hour ambulatory blood pressure monitoring (ABPM) at Rady Children’s Hospital from August 2018 to January 2019 and had a spot urine protein to creatinine ratio (PCR) measurement within one year of their ABPM. Dipping was defined as ≥10% reduction in systolic and diastolic blood pressure from day to night. Multivariable logistic and linear regression models evaluated the association of proteinuria with dipping, employing backwards selection models to retain important confounders.

Results

Seventy-seven children had ABPM and urine PCR assessments during the study period, among whom 27 (35.1%) were non-dippers. Non-dippers had a higher left ventricular mass index as compared to dippers (mean difference 6.9 g/m2.7, 95% CI 1.6 to 12.2). Doubling of urine PCR was associated with 38% higher odds of non-dipping in the multivariable model (Table). Doubling of urine PCR was also associated with a lower diastolic dipping percent by 1.33 (95% CI 0.31 to 2.34), after adjusting for age, body mass index, and estimated glomerular filtration rate.

Conclusion

Proteinuria is significantly associated with non-dipping in children. Pediatric patients with non-dipping should be evaluated with urine PCR, and conversely, those with proteinuria may benefit from a 24-hour ABPM.

Funding

  • NIDDK Support