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Updated: Oct 13, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Nocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort
Christine Y Bakhoum1, Ronit Katz2, Joshua A Samuels3
1Department of Pediatrics, Section of Pediatric Nephrology, Yale University, New Haven, Connecticut.
Insights
In children with chronic kidney disease (CKD), Black race, female sex, higher proteinuria, and sodium intake are linked to a blunted nocturnal blood pressure (BP) decline. No significant association was found between this BP nondipping and left ventricular mass index.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Hypertension Research
Background:
- Physiologic nocturnal blood pressure (BP) decline is often reduced in children with chronic kidney disease (CKD).
- The clinical implications of this BP nondipping phenomenon in pediatric CKD are not well understood.
- Understanding risk factors and consequences is crucial for managing cardiovascular health in these young patients.
Purpose of the Study:
- To identify risk factors associated with BP nondipping in children with CKD.
- To investigate the relationship between BP nondipping and left ventricular mass index (LVMI) in this population.
- To provide insights into potential cardiovascular complications in pediatric CKD.
Main Methods:
- Cross-sectional analysis of ambulatory BP monitoring and echocardiographic data from the Chronic Kidney Disease in Children study.
- Multivariable regression analyses were employed to assess associations.
- Risk factors for dipping and the association of dipping with LVMI were evaluated.
Main Results:
- 41% of 552 pediatric CKD participants were classified as nondippers.
- In nonglomerular CKD, female sex and higher sodium intake correlated with reduced systolic and diastolic dipping.
- In glomerular CKD, Black race and greater proteinuria were linked to reduced systolic and diastolic dipping.
- No statistically significant association was observed between systolic or diastolic dipping and LVMI, though nonlinear trends were noted for diastolic dipping.
Conclusions:
- Risk factors for blunted nocturnal BP decline in children with CKD include Black race, female sex, increased proteinuria, and higher sodium intake.
- The study did not find a statistically significant link between BP dipping status and LVMI in pediatric CKD patients.
- Further research may be needed to explore the subtle, potentially nonlinear, relationship between diastolic BP dipping and LVMI.
Background And Objectives:
The physiologic nocturnal BP decline is often blunted in patients with CKD; however, the consequences of BP nondipping in children are largely unknown. Our objective was to determine risk factors for nondipping and to investigate if nondipping is associated with higher left ventricular mass index in children with CKD.
Design, Setting, Participants, & Measurements:
We conducted a cross-sectional analysis of ambulatory BP monitoring and echocardiographic data in participants of the Chronic Kidney Disease in Children study. Multivariable linear and spline regression analyses were used to evaluate the relationship of risk factors with dipping and of dipping with left ventricular mass index.
Results:
Within 552 participants, mean age was 11 (±4) years, mean eGFR was 53 (±20) ml/min per 1.73 m2, and 41% were classified as nondippers. In participants with nonglomerular CKD, female sex and higher sodium intake were significantly associated with less systolic and diastolic dipping (P≤0.05). In those with glomerular CKD, Black race and greater proteinuria were significantly associated with less systolic and diastolic dipping (P≤0.05). Systolic dipping and diastolic dipping were not significantly associated with left ventricular mass index; however, in spline regression plots, diastolic dipping appeared to have a nonlinear relationship with left ventricular mass index. As compared with diastolic dipping of 20%-25%, dipping of <20% was associated with 1.41-g/m2.7-higher left ventricular mass index (95% confidence interval, -0.47 to 3.29), and dipping of >25% was associated with 1.98-g/m2.7-higher left ventricular mass index (95% confidence interval, -0.77 to 4.73), although these relationships did not achieve statistical significance.
Conclusions:
Black race, female sex, and greater proteinuria and sodium intake were significantly associated with blunted dipping in children with CKD. We did not find a statistically significant association between dipping and left ventricular mass index.
Podcast:
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_12_20_CJN09810721.mp3.
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