Association of blood pressure variability and neurocognition in children with chronic kidney disease

Abstract

Background Children with chronic kidney disease (CKD) and hypertension have increased blood pressure variability (BPV). Increased BPV has been associated with lower neurocognitive test scores in adults. Children with CKD are at risk for decreased neurocognitive function. Our objective was to determine if children with CKD and increased BPV had worse performance on neurocognitive testing compared with children with CKD and lower BPV. Methods This was a cross-sectional and longitudinal analysis of the relation between BPV and neurocognitive test performance in children 6 years and older enrolled in the Chronic Kidney Disease in Children (CKiD) study. Visit-to-visit BPV was assessed by the standard deviation of visit BPs (BPV-SD) and average real variability (ARV). Ambulatory BPV was assessed by SD of wake and sleep periods on 24hr ambulatory BP monitoring. Results 650 subjects had a mean follow-up period of 4.0 years. Subjects with systolic visit-to-visit BPV in the upper tertile had lower scores on Delis–Kaplan Executive Function System (D-KEFS) Verbal Category Switching than those with BPV in the lower tertile (BPV-SD, 8.3 vs. 9.5, p = 0.006; ARV, 8.5 vs. 9.6, p = 0.02). On multivariate analysis, the association between lower Category Switching score and increased BPV remained significant after controlling for mean BP, demographic characteristics, and disease-related variables (BPV-SD, β = −0.7, 95% confidence interval [CI]: −1.28 to −0.12; ARV, CI: −1.05 to −0.02). Ambulatory BPV was not independently associated with any cognitive measure. Conclusions Higher systolic visit-to-visit BPV was independently associated with decreased D-KEFS Category Switching scores in children with mild-to-moderate CKD.

Hypertension in pediatric patients with chronic kidney disease: management challenges

“…89 LVH may be evident in hypertensive children with CKD. 5,9,36,[89][90][91][92] Twenty percent of children in the CKiD cohort with CKD stage II-IV exhibited LVH. 9 Confirmed HTN and masked HTN were the strongest predictors of LVH in children with CKD.…”

“…93,94 Interestingly, pediatric patients with HTN were also found to have decreased performance in a variety of cognitive tests relative to their normotensive counterparts. 91,92 Monitoring for HTN in children with CKD Appropriate BP management is critical for reducing the risk of mortality in CKD. 95 Diagnosis and monitoring of HTN depends on accurate BP measurements; however, this is complicated in patients with CKD due to disease-induced alterations in diurnal BP rhythms.…”

Суточный Профиль Артериального Давления У Детей С Хроническим Пиелонефритом И Хронической Болезнью Почек I–III Стадии

“…AH is considered to be one of the main factors contributing to the progression of CKD, increasing the risk of cardiovascular complications and suppressing neurocognitive functions [12,13]. Our results of BP studies suggest that the number of hypertensive patients increases in CKD progression towards the terminal stage of chronic renal failure.…”

Association Between Chronic Kidney Disease–Mineral Bone Disease (CKD-MBD) and Cognition in Children: Chronic Kidney Disease in Children (CKiD) Study

“…The CKiD Study is a prospective observational study that enrolled 891 children aged 1 to 16 years with estimated glomerular filtration rates (eGFRs) between 30 and 90 mL/min/1.73 m 2 at 54 centers across North America from January 2005 to March 2015. 7 , 30 , 31 , 32 The study design, methods, and exclusion criteria have been described previously. 30 The study was approved by the UCSF Institutional Review Board #18-25119, and all participants provided informed consent.…”