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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Blood pressure control and left ventricular mass in children with chronic kidney disease
Manish D Sinha1, Shane M Tibby, Pernille Rasmussen
1Department of Pediatric Nephrology, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, UK. manish.sinha@gstt.nhs.uk
Insights
Left ventricular hypertrophy (LVH) is common in children with chronic kidney disease (CKD). Even without overt hypertension, higher blood pressure (BP) and calcium intake are linked to LVH, suggesting current BP targets may need re-evaluation.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Hypertension Research
Background:
- Heart disease is a leading cause of mortality in young adults with chronic kidney disease (CKD).
- Left ventricular hypertrophy (LVH), a thickening of the heart's main pumping chamber, is prevalent in children with CKD and often linked to hypertension.
- The appropriateness of current blood pressure (BP) control targets in pediatric CKD requires investigation.
Purpose of the Study:
- To investigate the relationship between LVH and BP in children with CKD.
- To determine if existing BP control targets are adequate for this population.
- To explore potential contributing factors to LVH in pediatric CKD.
Main Methods:
- A single-center, cross-sectional study involving 49 nonhypertensive children with CKD.
- Echocardiography was used to assess left ventricular mass index (LVMI).
- Clinic and 24-hour ambulatory BP monitoring were performed, alongside analysis of biochemical data and prior BP records.
Main Results:
- Nearly half (49%) of the children exhibited LVH, with a mean LVMI of 37.8 ± 9.1 g/m²·⁷.
- Children with LVH had higher BP readings than those without, despite not meeting criteria for overt hypertension.
- Systolic BP, particularly clinic measurements, showed a strong correlation with LVMI. Elemental calcium intake was also positively associated with LVMI.
Conclusions:
- LVH is associated with elevated systolic BP in pediatric CKD patients, even without overt hypertension.
- Current BP control targets in children with CKD may need re-evaluation.
- The link between LVH and elemental calcium intake raises concerns about the use of calcium-based phosphate binders in this patient group.
Background And Objectives:
Heart disease is a major cause of death in young adults with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is common and is associated with hypertension. The aims of this study were to evaluate whether there is a relationship between LVH and BP in children with CKD and whether current targets for BP control are appropriate.
Design, Setting, Participants, & Measurements:
In this single-center cross-sectional study, 49 nonhypertensive children, (12.6 ± 3.0 years, mean GFR 26.1 ± 12.9 ml/min per 1.73 m²) underwent echocardiographic evaluation and clinic and 24-hour ambulatory BP monitoring. LVH was defined using age-specific reference intervals for left ventricular mass index (LVMI). Biochemical data and clinic BP for 18 months preceding study entry were also analyzed.
Results:
The mean LVMI was 37.8 ± 9.1 g/m²·⁷, with 24 children (49%) exhibiting LVH. Clinic BP values were stable over the 18 months preceding echocardiography. Patients with LVH had consistently higher BP values than those without, although none were overtly hypertensive (> 95th percentile). Multiple linear regression demonstrated a strong relationship between systolic BP and LVMI. Clinic systolic BP showed a stronger relationship than ambulatory measures. Of the confounders evaluated, only elemental calcium intake yielded a consistent, positive relationship with LVMI.
Conclusions:
LVMI was associated with systolic BP in the absence of overt hypertension, suggesting that current targets for BP control should be re-evaluated. The association of LVMI with elemental calcium intake questions the appropriateness of calcium-based phosphate binders in this population.
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