Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease

Abstract

Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3–5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population.

Asian management of hypertension: Current status, home blood pressure, and specific concerns in India

“…One more small study analyzed the role of genetic factors in BPV among the Kumba community, which showed significant differences in 24‐hour mean BP values, BPV, and nocturnal dipping in systolic BP. One study has demonstrated the feasibility of ABPM in children too . In another study in children with CKD on dialysis, there was a high prevalence of ambulatory hypertension, up to 90% .…”

Суточный Профиль Артериального Давления У Детей С Хроническим Пиелонефритом И Хронической Болезнью Почек I–III Стадии

“…These data can be an argument to conclude that BP normal level assessed by a single office measurement does not allow ruling out masked AH in CKD children. Therefore, it is now recommended to perform 24-hour ABPM for all CKD children regardless of BP level assessed by a single office BP measurement [17][18][19].…”

Computer tomography urography assisted real-time ultrasound-guided percutaneous nephrolithotomy on renal calculus

“…[10] Ultrasound has no radiation and can be employed to position the renal calculi. Thus, it has been widely used to aid nephroscopy.…”