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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Blood pressure abnormalities in children with chronic kidney disease
Janis M Dionne1, Margaret M Turik, Robert M Hurley
1Division of Nephrology, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada. jdionne@cw.bc.ca
Insights
Ambulatory blood pressure monitoring reveals significant nocturnal hypertension and abnormal dipping in children with chronic kidney disease (CKD). These findings highlight the need for 24-h BP monitoring in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health
- Hypertension Research
Background:
- Blood pressure (BP) rhythm disturbances are linked to renal impairment.
- Understanding BP patterns in pediatric chronic kidney disease (CKD) is crucial.
Purpose of the Study:
- To determine the prevalence of BP abnormalities in children with CKD.
- To identify factors associated with nocturnal BP abnormalities.
Main Methods:
- 42 children (2-19 years) with CKD stages 2-5 underwent 24-h ambulatory BP monitoring.
- Analysis focused on nocturnal hypertension, BP load, and nocturnal dipping patterns.
Main Results:
- Nocturnal hypertension affected 14% (systolic) and 24% (diastolic) of patients.
- Elevated BP load (>50%) was observed in a similar percentage.
- 49% had BP abnormalities missed by casual BP measurements.
- Decreased estimated glomerular filtration rate correlated with reduced nocturnal BP dipping.
- Proteinuria was linked to nocturnal BP nondipping.
Conclusions:
- 24-h ambulatory BP monitoring offers valuable insights into hypertension in pediatric CKD patients, even at stage 2.
- Nocturnal hypertension, elevated BP load, and nocturnal BP nondipping are common and often undetected by standard BP measurements.
Objectives:
Disturbances of blood pressure (BP) rhythms have been demonstrated in patients with various degrees of renal impairment. The purpose of this study was to determine the prevalence of BP abnormalities in children with chronic kidney disease (CKD) and evaluate possible factors associated with nocturnal BP abnormalities.
Methods:
42 children between 2 and 19 years of age with CKD stages 2-5 completed 24-h ambulatory BP monitoring.
Results:
The percentage of patients with daytime hypertension was less than 10% but rates were higher at nighttime where 14% had systolic and 24% diastolic hypertension. A similar percentage of patients had a BP load >50%. BP abnormalities that were not evident in clinic BP readings were identified in 49% of the participants. The nocturnal BP dipping percentage tended to decrease as the estimated glomerular filtration rate decreased. Proteinuria was significantly associated with nocturnal BP nondipping.
Conclusion:
24-h ambulatory BP monitoring may provide additional insight into hypertension in pediatric patients as early as CKD stage 2. Several BP abnormalities were identified that were not evident in casual BP measurements including nocturnal hypertension, elevated BP load, and nocturnal BP nondipping.
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