Abstract: FR-PO0731
Home vs. Clinic Blood Pressures as Predictors of CKD Progression in the CKiD Study
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Legaspi, Sabrina, University of California San Francisco, San Francisco, California, United States
- Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 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
- Ng, Derek K., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Lin, Feng, University of California San Francisco, San Francisco, California, United States
- Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background
Lowering 24-hour ambulatory blood pressures (ABP) confers kidney benefit in children with CKD. However, 24-hour ABP monitoring is cumbersome and only captures 1 day of data. Home BP monitoring may be an attractive alternative and capture ABPs over days to identify masked/white coat hypertension. Whether home BPs are more predictive of CKD progression than clinic BPs in children is unclear. We investigated this question with data from the Chronic Kidney Disease in Children (CKiD) Study.
Methods
The CKiD Study (a multisite, observational cohort) conducts annual study visits where manual clinic BPs are ascertained. A home BP substudy was added in 2017 where participants obtain home BPs twice daily for 1-week after their annual visit using a Qardioarm device. In this interim report, we used nested logistic regression models to compare clinic vs. home BPs on the composite kidney outcome of 50% decline in eGFR or KRT. Models first included clinic BPs; home BPs were later added and c-statistics compared. Adjusted models accounted for age, sex, and eGFR.
Results
Out of 73 participants (59% male; mean age 17±3.9 yrs and eGFR 54.7ml/min/1.73m2 ±19.2), 13 reached the kidney outcome. Mean home systolic BP(SBP) was 10.5mmHg higher than clinic SBP (±10.1mmHg); home diastolic (DBP) was 2.3mmHg (±8.9mmHg) higher than clinic DBP. Clinic BPs did not predict the kidney outcome in unadjusted analysis (Model 1,Table), and risk discrimination was low (c=0.54). When home BPs were added (Model 2), c-statistics improved (c=0.62), but home BP was also not predictive of the outcome. In adjusted analysis, home BP was predictive of the outcome. Every 5 mmHg higher home SBP was associated with 2.1-fold higher odds of the kidney outcome (Model 4). Addition of home BPs (c=0.92) to clinic BPs (c=0.89) continued to improve risk discrimination in adjusted models.
Conclusion
Home BPs were more predictive of CKD progression than clinic BPs in children. Home BP monitoring in routine care may provide important prognostic value.
Funding
- NIDDK Support – Abbott Laboratories