[24-hour pulse pressure in children with chronic kidney disease]

The aim of the study was to assess 24-h pulse pressure (PP) and to determine relationships between PP and echocardiographic parameters of left ventricle in children with chronic kidney disease (CKD). The study population included 47 children (mean age: 13.11 yrs) with CKD treated conservatively (n=14), with hemodialysis (HD) (n=13) and automated peritoneal dialysis (APD) (n=20). Retrospectively, antropometrical data, office blood pressure, ambulatory blood pressure monitoring (ABPM) variables and LV parameters in echocardiogaphy were analyzed. In study subjects, hypertension (HTN) was present in 25 (53.19%) and in 29 (61.7%) when based on office blood pressure and ABPM respectively. The prevalence of HTN was the highest in predialysis patients. 21 (44.6%) of children had left ventricular hypertrophy (LVH), which was the most frequently found in HD group. The mean PP value was 45.26 +/- 7.56 mmHg and was similar in all groups. Positive correlations were found between PP and weight (p < 0.001), height (p < 0.05), body surface area (p < 0.01) and LV measures (LV mass, LV posterior wall thickness and diastolic diameter of LV, all p < 0.05). Children with PP above median had tendency for greater LV mass (p = 0.06). There was no difference in severity of blood pressure and PP in children with/without LVH. However, in 45% of patients LVH was noted in whom the value of PP was greater than calculated normative value of PP (95 centile). HTN and LVH is common in children with CKD. A mean PP in children with CKD is lower when compared to adult population with CKD. The results confirm that PP increases with the age and an increasing PP has an influence on the changes of LV geometry. Assessment of PP in ABPM might help in identifying those with abnormal LV geometry.