Ambulatory hypertension in a pediatric cohort of sickle cell disease

Moodalbail, Divya G.; Falkner, Bonita; Keith, Scott W.; Mathias, Robert; Araya, Carlos E.; Zaritsky, Joshua J.; Stuart, Marie J.

doi:10.1016/j.jash.2018.04.005

Cited by 17 publications

(19 citation statements)

References 36 publications

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“…Next, we and others have demonstrated that 24 hour ambulatory blood pressure monitoring (ABPM) is superior to in‐clinic BP for defining hypertension in pediatric SCA but we do not approach participants to complete 24 hour ABPM until they are in early adolescence. With the concern for the reliability of in‐clinic BP measurements in young children obtained during the stress of triage and blood collection that were not confirmed with 24 hour ABPM, we did not include an analysis of hypertension from 4 to 10 years of age on the development of early albuminuria. Finally, we could not include HbF or NSAID therapy as risk variables in this analysis as we do not obtain annual fetal hemoglobin levels in patients on transfusion therapy or no SCA modifying therapy nor do we record the timing of the most recent dose of NSAID therapy prior to obtaining cystatin C …”

Section: Discussionmentioning

confidence: 99%

Hyperfiltration during early childhood precedes albuminuria in pediatric sickle cell nephropathy

et al. 2019

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Background In patients with diabetes mellitus, hyperfiltration precedes the development of albuminuria. Pediatric sickle cell anemia (SCA) patients have a high prevalence of hyperfiltration and albuminuria during early childhood and adolescence. We tested the hypothesis that hyperfiltration precedes the development of albuminuria in a longitudinal pediatric SCA cohort. Methods We identified 91 participants with HbSS or SB0 thalassemia 5‐21 years of age enrolled in a longitudinal sickle cell nephropathy cohort study who had a cystatin C measured during early childhood (4‐10 years of age). Early hyperfiltration was defined as a mean eGFR >180 mL/min/1.73m2 using cystatin C obtained from 4 to 10 years of age. Persistent albuminuria was defined as an albumin to creatinine ratio > 30 mg/g on two of three untimed urine specimens. Time to event analysis estimated survival curves for participants with and without hyperfiltration using Kaplan‐Meier curves and used logrank test for categorical variables to assess the association with time to development of the first episode persistent albuminuria. Results Persistent albuminuria occurred more often and at an earlier age in participants with early hyperfiltration compared to those without early hyperfiltration (log‐rank, P = .004). Participants who developed albuminuria have a significant increase in their eGFR during childhood (P = .003) as compared to participants who have not yet progressed to albuminuria (P = .26). For every 1 g/dL increase in hemoglobin, the hazard ratio for developing persistent proteinuria decreased by 0.56 (95% CI: 0.3, 1.06, P = .07). Conclusion Hyperfiltration precedes the development of persistent proteinuria in pediatric SCA patients. Intervention strategies should target lowering eGFR during early childhood.

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Section: Discussionmentioning

confidence: 99%

Hyperfiltration during early childhood precedes albuminuria in pediatric sickle cell nephropathy

et al. 2019

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“…However, masked hypertension is common in pediatric SCD and could contribute to SCN pathophysiology [32,33]. These processes are summarized in Figure 1.…”

Section: Pathophysiologymentioning

confidence: 99%

Sickle Cell Nephropathy in the Pediatric Population

et al. 2018

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Background: Compared to the past, patients with sickle cell disease (SCD) currently live longer due to improvements in diagnosis and comprehensive care. Due to these advances, long-term chronic complications pose a greater challenge in the management of patients with SCD. In particular, sickle cell nephropathy (SCN) is associated with significant morbidity and mortality across all age groups. Furthermore, SCN is an understudied condition with relatively few symptoms and therefore requires close surveillance. In this review, we sought to explore the epidemiology, natural history, and treatment options for SCN with an emphasis on the pediatric population. Summary: SCN invariably begins in childhood with evidence of structural changes detected as early as infancy. These indolent changes can progress undetected to advanced chronic kidney disease by late adolescence or early adulthood. The risk factors for progression are not well defined, but significant albuminuria (which is also the most common presentation in childhood) is a key factor in progression. One of the main challenges in understanding SCN in children is the poor correlation between estimated and measured glomerular filtration rates. Another challenge is the lack of large-scale longitudinal studies that track the clinical outcomes of pediatric patients over time. Several studies aim to identify early biomarkers of SCN in children, as albuminuria presents only following significant chronic damage. The utility of angiotensin converting enzyme inhibitors and hydroxyurea in treating albuminuria is addressed here as well as novel treatments that may be of benefit.

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“…8,23 In a multicenter clinical trial including 814 children with lence of MH, ranging from 25% up to 35%, in children with SCD. [24][25][26] The above finding may explain the higher risk for adverse cerebrovascular 8 or renal 27,28 outcomes in SCD children with normal office BP level.…”

Section: Discussionmentioning

confidence: 92%

Unmasking hypertension in children and adolescents with sickle/beta‐thalassemia

Stabouli¹,

Antza

Papadopoulou³

et al. 2020

J of Clinical Hypertension

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Sickle cell disease (SCD) is associated with increased risk of cardiovascular disease, although blood pressure (BP) levels have been reported to be lower in SCD patients compared to general population. Aims of the present study were to investigate the prevalence of BP phenotypes and levels of arterial stiffness in pediatric patients with SCD and to assess the differences with children at risk for hypertension. We included in the study 16 pediatric SCD (HbS/β‐thalassemia, S/β‐thal) patients and 16 consecutive children at risk for hypertension referred to our hypertension clinic that served as high‐risk controls. All patients underwent ambulatory BP monitoring and measurement of carotid‐femoral pulse wave velocity (PWV). S/β‐thal patients had lower office systolic BP than the high‐risk control group (115.43 ± 10.03 vs 123.37 ± 11.92, P = .05) but presented similar levels of day and night ambulatory BP. Office hypertension was found in 12.5% of the S/β‐thal patients and in 43.8% of the high‐risk controls (P = .06), while 18.8% of the S/β‐thal patients and 25% of the high‐risk controls presented hypertension by ambulatory BP levels (P = .21). All of the S/β‐thal patients with ambulatory hypertension had night hypertension (one combined night and day hypertension) with office normotension (masked hypertension). S/β‐thal patients and high‐risk controls presented equal prevalence of masked hypertension (18.8%). Children and adolescents with S/β‐thal present similar prevalence of BP phenotypes and levels of PWV with children at risk for hypertension. A significant number of children and adolescents with S/β‐thal may have masked nighttime hypertension despite normal office BP levels.

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Ambulatory hypertension in a pediatric cohort of sickle cell disease

Cited by 17 publications

References 36 publications

Hyperfiltration during early childhood precedes albuminuria in pediatric sickle cell nephropathy

Hyperfiltration during early childhood precedes albuminuria in pediatric sickle cell nephropathy

Sickle Cell Nephropathy in the Pediatric Population

Unmasking hypertension in children and adolescents with sickle/beta‐thalassemia

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