260 - Longitudinal Trends in 24-Hour ABPM in Pediatric Patients with CKD

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 260
Publication Number: 260.251

Victoria Besser, Cincinnati Children's Hospital Medical Center, CINCINNATI, OH, United States; Donna J. Claes, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Mark Mitsnefes, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Presenting Author(s)

VB

Victoria Besser, MD (she/her/hers)

Clinical Fellow
Cincinnati Children's Hospital Medical Center
CINCINNATI, Ohio, United States

Background: Hypertension (HTN) is present in ~50% of pediatric patients with chronic kidney disease (CKD) and is an independent predictor for disease progression. 24-hour ambulatory blood pressure monitoring (ABPM) is the best tool in diagnosis and monitoring of HTN.

Objective: We aimed to longitudinally evaluate ABPM trends and identify factors associated with changes in BP control within our single-center pediatric CKD population.

Design/Methods: We completed a retrospective analysis of patients aged < 25 years with CKD I-V who had 2 or more ABPM studies. ABPM data [i.e. mean 24-hour, wake, and sleep SBP + DBP; classification] were collected. Relevant patient data [i.e. age, gender assigned at birth, race, etiology of kidney disease, BMI, eGFR, antihypertensive medications] at time of each ABPM were also obtained.

Results: 122 unique patients (59% male; mean age 12.7 years at first ABPM; 80.7% white; 17% glomerular disease, 54% non-glomerular disease, 29% secondary/other; mean eGFR [CKiD U25] 70.9mL/min/1.73m2) had 302 ABPM studies completed (75 patients with 2 studies, 39 patients with 3 studies, 7 patients with 4+ studies) with an average of 35.8 months between 1st and last study. At the time of last ABPM, there was an increase in BMI (21.5 to 25.4, p 0.019) and a trend towards worsening eGFR (60-89: 43.7% to 25%, p = 0.004; 30-59: 32.8% to 44.2%, p = 0.094). We also noted an increase in antihypertensive use (0.69 meds/patient to 0.94 meds/patient, p = 0.038) and improved BP control per ABPM (normal: 46.7% to 65.6%, p = 0.004; sustained: 36.1% to 22.1%, p = 0.024).

Conclusion(s): Despite worsening BMI and kidney function, pediatric CKD patients demonstrated a significant improvement in BP control on repeat ABPM, likely related to increased use of antihypertensive medications.