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Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD.

Authors
  • Lee, Jason1, 2
  • McCulloch, Charles E3
  • Flynn, Joseph T4
  • Samuels, Joshua5
  • Warady, Bradley A6
  • Furth, Susan L7
  • Seth, Divya8, 2, 9, 10
  • Grimes, Barbara A3
  • Mitsnefes, Mark M11
  • Ku, Elaine8, 2, 3, 9, 10
  • 1 Division of Pediatric Nephrology, University of California San Francisco, San Francisco, California; [email protected]
  • 2 Department of Pediatrics, University of California San Francisco, San Francisco, California.
  • 3 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
  • 4 Division of Nephrology, Department of Pediatrics, Seattle Children's, Seattle, Washington.
  • 5 Division of Pediatric Nephrology, Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas.
  • 6 Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
  • 7 Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • 8 Division of Pediatric Nephrology, University of California San Francisco, San Francisco, California.
  • 9 Division of Nephrology, University of California San Francisco, San Francisco, California.
  • 10 Department of Internal Medicine, University of California San Francisco, San Francisco, California; and.
  • 11 Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Type
Published Article
Journal
Clinical Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Apr 07, 2020
Volume
15
Issue
4
Pages
493–500
Identifiers
DOI: 10.2215/CJN.10130819
PMID: 32160993
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Elevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs. We studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters. Overall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load. BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3. Copyright © 2020 by the American Society of Nephrology.

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