Blood pressure abnormalities in children with chronic kidney disease

Abstract

Disturbances of blood pressure (BP) rhythms have been demonstrated in patients with various degrees of renal impairment. The purpose of this study was to determine the prevalence of BP abnormalities in children with chronic kidney disease (CKD) and evaluate possible factors associated with nocturnal BP abnormalities. 42 children between 2 and 19 years of age with CKD stages 2-5 completed 24-h ambulatory BP monitoring. The percentage of patients with daytime hypertension was less than 10% but rates were higher at nighttime where 14% had systolic and 24% diastolic hypertension. A similar percentage of patients had a BP load >50%. BP abnormalities that were not evident in clinic BP readings were identified in 49% of the participants. The nocturnal BP dipping percentage tended to decrease as the estimated glomerular filtration rate decreased. Proteinuria was significantly associated with nocturnal BP nondipping. 24-h ambulatory BP monitoring may provide additional insight into hypertension in pediatric patients as early as CKD stage 2. Several BP abnormalities were identified that were not evident in casual BP measurements including nocturnal hypertension, elevated BP load, and nocturnal BP nondipping.