Blood Pressure Control and Left Ventricular Mass in Children with Chronic Kidney Disease

Abstract

SummaryBackground and objectives Heart disease is a major cause of death in young adults with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is common and is associated with hypertension. The aims of this study were to evaluate whether there is a relationship between LVH and BP in children with CKD and whether current targets for BP control are appropriate.Design, setting, participants, & measurements In this single-center cross-sectional study, 49 nonhypertensive children, (12.6 Ϯ 3.0 years, mean GFR 26.1 Ϯ 12.9 ml/min per 1.73 m 2 ) underwent echocardiographic evaluation and clinic and 24-hour ambulatory BP monitoring. LVH was defined using age-specific reference intervals for left ventricular mass index (LVMI). Biochemical data and clinic BP for 18 months preceding study entry were also analyzed. ResultsThe mean LVMI was 37.8 Ϯ 9.1 g/m 2.7 , with 24 children (49%) exhibiting LVH. Clinic BP values were stable over the 18 months preceding echocardiography. Patients with LVH had consistently higher BP values than those without, although none were overtly hypertensive (Ͼ95th percentile). Multiple linear regression demonstrated a strong relationship between systolic BP and LVMI. Clinic systolic BP showed a stronger relationship than ambulatory measures. Of the confounders evaluated, only elemental calcium intake yielded a consistent, positive relationship with LVMI.Conclusions LVMI was associated with systolic BP in the absence of overt hypertension, suggesting that current targets for BP control should be re-evaluated. The association of LVMI with elemental calcium intake questions the appropriateness of calcium-based phosphate binders in this population.

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

“…Using the same normative data, a recent smaller, single-center cross-sectional study in 49 nonhypertensive CKD children found a 49% prevalence of LVH (24 of 49 subjects). 3 Although the mean GFR in that study was lower (26.1 ml/min per 1.73 m 2 ) than in our study (43.8 ml/min per 1.73 m 2 ), reflecting more advanced kidney disease, a significant relationship of GFR with LVH was not found, suggesting that the difference is not explained by declining kidney function. Similarly, our previous cross-sectional study 2 as well as current analysis showed no association of kidney function (measured GFR) with LVH.…”

“…[1][2][3][4]15 One of the important findings of our current longitudinal study is the confirmation of a strong association between casual BP and LVMI in the CKiD population. The multivariate model predicting LVMI with SBP also showed that, after adjusting for SBP and confounders (including age), LVMI had an average decrease of 40% over 4 years.…”

“…[1][2][3][4][5]16 Previous cross-sectional analysis in the CKiD cohort (n=366) reported a 17% prevalence of LVH at baseline. 2 Our present longitudinal study, in a larger population (n=478), showed similar prevalence of LVH at baseline (V2) of 16%.…”

“…[1][2][3][4][5] Some data in children with CKD suggest that the development of LVH is associated with other cardiac abnormalities, such as impaired systolic function. [6][7][8][9] Thus, understanding the factors that contribute to LVH in children with CKD may lead to interventions to reduce future cardiovascular risk.…”

“…[10][11][12] However, the link between elevated BP and LVH in children with CKD remains controversial. [1][2][3]15 To better understand the relationships between BP and LVH in children with CKD, we analyzed BP and echocardiographic data from children enrolled in the Chronic Kidney Disease in Children (CKiD) cohort, a prospective observational study of children with mild to moderate CKD. The objectives of this study were to (1) analyze the longitudinal effects of casual BP on left ventricular mass index (LVMI) and (2) determine whether casual BP is associated with the development and/or regression of LVH in children with CKD.…”