Back to Search
Start Over
Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2020 Apr 07; Vol. 15 (4), pp. 493-500. Date of Electronic Publication: 2020 Mar 11. - Publication Year :
- 2020
-
Abstract
- Background and Objectives: 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.<br />Design, Setting, Participants, & Measurements: 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.<br />Results: 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.<br />Conclusions: BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD.<br />Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020&#95;03&#95;11&#95;CPOD10130819.mp3.<br /> (Copyright © 2020 by the American Society of Nephrology.)
- Subjects :
- Adolescent
Age Factors
Child
Child, Preschool
Cross-Sectional Studies
Disease Progression
Female
Humans
Hypertension epidemiology
Hypertension physiopathology
Hypertrophy, Left Ventricular epidemiology
Hypertrophy, Left Ventricular physiopathology
Infant
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic physiopathology
Longitudinal Studies
Male
Predictive Value of Tests
Prevalence
Prognosis
Prospective Studies
Renal Insufficiency, Chronic epidemiology
Renal Insufficiency, Chronic physiopathology
Risk Assessment
Risk Factors
United States epidemiology
Ventricular Function, Left
Ventricular Remodeling
Blood Pressure
Blood Pressure Monitoring, Ambulatory
Hypertension diagnosis
Renal Insufficiency, Chronic diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 15
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 32160993
- Full Text :
- https://doi.org/10.2215/CJN.10130819