Diastolic Function and Ambulatory Hypertension in Children With Chronic Kidney Disease. Issue 5 (November 2021)

• Record Type: Journal Article
• Authors: Mitsnefes, Mark M.; Xu, Yunwen; Ng, Derek K.; Hill, Garick; Kimball, Thomas; Furth, Susan L.; Warady, Bradley A.
• Is Part Of: Hypertension. Volume 78:Issue 5(2021)
• Publication Date: 2021-11
• Subjects: blood pressure -- cardiovascular disease -- glomerular filtration rate -- heart -- hypertrophy; Hypertension -- Periodicals; Hypertension -- Treatment -- Periodicals; 616.132005
• DOI: 10.1161/HYPERTENSIONAHA.121.17449
• Languages: English
• ISSNs: 0194-911X

Abstract

Abstract : Diastolic dysfunction is one of the earliest cardiac abnormalities in patients with chronic kidney disease. We analyzed echocardiographic markers of left ventricular function from 786 children and adolescents (1658 person-visits) enrolled in the CKiD (Chronic Kidney Disease in Children) cohort, a large prospective observational study of children with chronic kidney disease. Primary outcome was early mitral inflow velocity-to-early mitral annular peak velocity (E/e′) ratio as a marker of left ventricular compliance. Abnormal diastolic function was defined as E/e′>8.0. Those with an abnormal E/e′ ratio were younger, had a lower estimated glomerular filtration rate and hemoglobin, and a higher prevalence of hypertension and left ventricular hypertrophy compared to children with a normal E/e′. In adjusted analysis, a higher E/e′ ratio was independently associated with ambulatory (sustained) hypertension (1.66 [95% CI, 1.15–2.42]). Other significant independent predictors were higher left ventricular mass index Z score, increased body mass index Z score, lower hemoglobin, higher phosphorus level, and younger age. Casual blood pressure was not significantly associated with higher E/e′. These data indicate that ambulatory blood pressure might better identify children with chronic kidney disease at risk for subclinical cardiac dysfunction than clinic blood pressure alone. Abstract : Supplemental Digital Content is available in the text.