Hypertension and Left Ventricular Hypertrophy in Pediatric Peritoneal Dialysis Patients: Ambulatory Blood Pressure Monitoring and Echocardiographic Evaluation

Abstract

Background: Hypertension is a frequent complication of end-stage renal disease and left ventricular hypertrophy (LVH) is common in patients with poorly controlled hypertension. The aim of this study was to evaluate hypertension in pediatric peritoneal dialysis (PD) patients, to compare casual and ambulatory blood pressure (BP) measurements and to evaluate the impact of BP parameters on LVH. Methods: The study comprised 25 PD patients (9 M, 16 F; mean age 14.14 ± 3.32 years) that have been followed in outpatient clinics. Medical records were reviewed for demographic features; casual BP measurements, ambulatory blood pressure monitoring (ABPM) and echocardiographic evaluation were applied to all patients. Results: The mean 24-hour and daytime systolic blood pressure (SBP) values were found to be higher than casual SBP (p < 0.001). Significant difference was present in the frequency of hypertension between casual SBP (32%) and the mean daytime SBP (56%) (p < 0.05). Nighttime systolic hypertension was detected in 14 (56%) and diastolic hypertension in 16 (64%) patients. Elevated daytime SBP load and DBP load were detected in 64 and 76% of the patients, respectively. Elevated nighttime SBP load and DBP load were detected in 72% of the patients. Seventeen (68%) patients had attenuated dipping for SBP. The mean left ventricular mass index (LVMI) was 52.65 ± 18.17 g/m^2.7 and 13 (52%) patients had LVH. LVMI was significantly correlated with casual BP measurements and the majority of ABPM parameters. Conclusion: The majority of pediatric PD patients had BP abnormalities in which severity was most accurately assessed with ABPM. Casual BP and majority of ABPM parameters were found to be significantly correlated with LVMI. Ambulatory blood pressure monitoring should be performed in all pediatric PD patients.

Ambulatory blood pressure monitoring: a versatile tool for evaluating and managing hypertension in children

“…Of the nondippers, three (10%) actually had a mean night BP higher than the day mean. As expected, these abnormalities extend into the dialysis and transplant populations as well [39][40][41]. Wuhl et al have also shown that shorter ultradian (<24 h) variation in BP is abnormal in children with chronic kidney disease along with this abnormal 24-h pattern [42].…”

Role of Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Children on Dialysis

“…Furthermore, ABPM provides load data, which quantifies true cardiovascular hypertensive burden. Although the use of ABPM in children receiving dialysis has been previously described (25)(26)(27)(28)(29)(30), overall number of patients in this subset studied to date is limited. In this study, we examined the potential benefit of addition of ABPM to casual-BP measurements in 24 stable pediatric dialysis patients.…”

Out-of-office blood pressure monitoring in chronic kidney disease

“…These data suggest that the prevalence of hypertension is similar in PD as it is among large groups of hemodialysis patients. The additive diagnostic value of ABPM was addressed in a small study of 25 pediatric PD patients using the 95th percentile thresholds to define hypertension based on office and ambulatory BPs [92]. The prevalence of hypertension increased from 32% with clinic BP readings to 56% based on daytime ambulatory BP.…”

“…The prevalence of hypertension increased from 32% with clinic BP readings to 56% based on daytime ambulatory BP. Furthermore, elevated nocturnal BP values were observed in approximately two out of three patients [92]. In a study of 32 PD patients, Wang et al [93] evaluated the relationship between home BP and 24-h BP.…”