MO1018IS LOW NORMAL BLOOD PRESSURE LEVEL IN PATIENTS WITH X-LINKED ALPORT SYNDROME OUR GOAL?

Abstract

Abstract Background and Aims The mean blood pressure <50th percentile for age, gender and height is recommended in children with chronic kidney disease, especially in case of proteinuria. The aim was to define the influence of low normal mean blood pressure level on the progression of renal disease in children with X-linked Alport syndrome (XLAS). Method mean day blood pressure normalized for sex, age, height (MBP), urine protein (mg/m2/day) and eGFR were assessed in retrospective single center study. Results The children with XLAS (n=69, 47M, age 9.49±4.18 years, eGFR=109±17.36 ml/min/1,73m2) were divided into 3 groups according the MBP level during follow up (4[3;5] years): (1) MBP<50‰ (n=27, 13М), (2) MBP 50-90‰ (n=33, 25M), (3) MBP≥90‰ (9М). The decline of eGFR (ml/min/1,73m2/year) was higher in male (-3[-0.8;-4.7] vs 0.2[-0.4;2]; χ2= 21.15587, p = 0.0067), in children with MBP ≥90‰ (0.65[-2.65;2] vs -2.3[-6;2.3] vs -3[-7.5;-1.8] in 1st, 2nd and 3 groups, respectively; р1,3=0.0091) and in patients with proteinuria (-2.5[-7;0.5] vs 0.2[-4;3]; p=0.0018). The risk of achieving eGFR<60 ml/min/1,73m2 was higher in pts of 3 group (OR=5.33, 95% CI 1.75;16.22) especially in the presence of proteinuria (OR=7.08, 95% CI 2.46;20.39). The multivariate analysis of predictive factors for eGFR reduction showed that the proteinuria (χ2=12.554, p=0.0019), the male gender (χ2=7.107, p=0.0077) and not MBP (χ2=5.4, p=0.07) were independent risk factors for eGFR decline. Conclusion The male gender and proteinuria are independent risk factors for renal disease progression in children with XLSA. We assumed that the goal of treatment, at least in XLAS’ patients with normal blood pressure, is to decrease proteinuria.