Kidney Week

Abstract: SA-PO675

Risk Factors for Incident Hypertension in Children with Mild-Moderate CKD (CKiD Study)

Session Information

• Pediatric Nephrology - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Vidi, Smitha R., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Smitha R. Vidi, MD

• Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Mark Mitsnefes, MD, MS

• Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States

Joseph T. Flynn, MD, MS, FASN

• Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States

Bradley A. Warady, MD

• Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth, MD, PhD

• Vongpatanasin, Wanpen, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Wanpen Vongpatanasin, MD

Background

Hypertension (HTN) affects > 50% of children with chronic kidney disease (CKD). Increased aortic stiffness contributes to the development of hypertension and left ventricular hypertrophy in adults. Electrolyte disturbances including hyperphosphatemia and hypercalcemia are known to be associated with vascular stiffness in adults as CKD progresses. However, the role of hypercalcemia and hyperphosphatemia in the development of arterial stiffness and incident HTN in the early stages of pediatric CKD is unknown.

Methods

We studied children aged 5-18 years with CKD (U25 eGFR 30-90 ml/min/1.73m2) who were normotensive without anti-HTN medications at baseline using data from the CKiD cohort. Aortic stiffness index (ASI) was measured by echocardiography; serum electrolytes and 24-hour ambulatory BP were measured at baseline and during at least one follow-up visit. HTN was defined as either wake/sleep mean SBP/DBP ≥ gender/height-specific 95^th percentile for <13 yrs of age and ≥ 130/80 mmHg for wake BP or ≥ 110/65 mmHg for sleep BP or mean ambulatory 24 hr BP ≥ 125/75 mmHg for ≥ 13 yrs of age.

Results

Out of 132 participants included in our study, 50 were not on anti-HTN medications. 26 participants had a follow up 24-hour ABPM study conducted 2 years after study entry. Mean age (76% males) was 11.6±3.7 yrs; mean eGFR 50±15 ml/min/1.73m2. 96% of participants on anti-HTN therapy and 92% without antihypertensives had abnormally high ASI compared to healthy controls. Higher baseline ASI and serum calcium were not associated with incident HTN at 2 years. Similarly, low serum potassium and phosphorous levels were not associated with incident HTN (Table) in unadjusted and adjusted analyses for age and eGFR.

Conclusion

Higher aortic stiffness index and serum calcium, potassium, and phosphorous were not associated with development of HTN after 2 yrs in children with CKD. Additional studies in larger cohorts or with longer follow-up times are needed.

Association of aortic stiffness and serum electrolytes with development of HTN

Funding

• NIDDK Support