TY - JOUR
T1 - BP control and left ventricular hypertrophy regression in children with CKD
AU - Kupferman, Juan C.
AU - Friedman, Lisa Aronson
AU - Cox, Christopher
AU - Flynn, Joseph
AU - Furth, Susan
AU - Warady, Bradley
AU - Mitsnefes, Mark
PY - 2014/1
Y1 - 2014/1
N2 - In adult patients with CKD, hypertension is linked to the development of left ventricular hypertrophy, but whether this association exists in children with CKD has not been determined conclusively. To assess the relationship between BP and left ventricular hypertrophy, we prospectively analyzed data from the Chronic Kidney Disease in Children cohort. In total, 478 subjects were enrolled, and 435, 321, and 142 subjects remained enrolled at years 1, 3, and 5, respectively. Echocardiograms were obtained 1 year after study entry and then every 2 years; BPwas measured annually. A linearmixedmodelwas used to assess the effect of BP on left ventricularmass index,whichwasmeasured at three different visits, and amixed logistic model was used to assess left ventricular hypertrophy. These models were part of a joint longitudinal and survivalmodel to adjust for informative dropout. Predictors of left ventricular mass index included systolic BP, anemia, and use of antihypertensive medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Predictors of left ventricular hypertrophy included systolic BP, female sex, anemia, and use of other antihypertensive medications. Over 4 years, the adjusted prevalence of left ventricular hypertrophy decreased from 15.3% to 12.6% in a systolic BP model and from 15.1% to 12.6% in a diastolic BP model. These results indicate that a decline in BP may predict a decline in left ventricular hypertrophy in children with CKD and suggest additional factors that warrant additional investigation as predictors of left ventricular hypertrophy in these patients.
AB - In adult patients with CKD, hypertension is linked to the development of left ventricular hypertrophy, but whether this association exists in children with CKD has not been determined conclusively. To assess the relationship between BP and left ventricular hypertrophy, we prospectively analyzed data from the Chronic Kidney Disease in Children cohort. In total, 478 subjects were enrolled, and 435, 321, and 142 subjects remained enrolled at years 1, 3, and 5, respectively. Echocardiograms were obtained 1 year after study entry and then every 2 years; BPwas measured annually. A linearmixedmodelwas used to assess the effect of BP on left ventricularmass index,whichwasmeasured at three different visits, and amixed logistic model was used to assess left ventricular hypertrophy. These models were part of a joint longitudinal and survivalmodel to adjust for informative dropout. Predictors of left ventricular mass index included systolic BP, anemia, and use of antihypertensive medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Predictors of left ventricular hypertrophy included systolic BP, female sex, anemia, and use of other antihypertensive medications. Over 4 years, the adjusted prevalence of left ventricular hypertrophy decreased from 15.3% to 12.6% in a systolic BP model and from 15.1% to 12.6% in a diastolic BP model. These results indicate that a decline in BP may predict a decline in left ventricular hypertrophy in children with CKD and suggest additional factors that warrant additional investigation as predictors of left ventricular hypertrophy in these patients.
UR - http://www.scopus.com/inward/record.url?scp=84891767245&partnerID=8YFLogxK
U2 - 10.1681/ASN.2012121197
DO - 10.1681/ASN.2012121197
M3 - Article
AN - SCOPUS:84891767245
SN - 1046-6673
VL - 25
SP - 167
EP - 174
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 1
ER -