Ambulatory blood pressure monitoring and subclinical inflammation in children with chronic kidney disease
Abstract
Background. Children with chronic kidney disease (CKD) are characterized by increased risk of hypertension and
chronic low-grade inflammation. The aim of the study was the analysis of relation between parameters of ambulatory
blood pressure monitoring (ABPM) and subclinical inflammation in children with CKD.
Material and methods. Study group included 27 paediatric patients (age 14.23 ± 3.57 years) with CKD stage 2–5;
18 children with previously recognized hypertension. In all patients we evaluated ABPM, office blood pressure,
complete blood count and selected clinical and biochemical parameters.
Results. In the study group, GFR was from 7.05 to 86.73, mean 40.88 ± 25.82 mL/min/1.73 m2. All 9 children
without hypertension had normal blood pressure in ABPM, but ABPM detected poor blood pressure control in 7
among 18 (38.9%) children with previously recognized and treated hypertension. Abnormal circadian blood pressure
profile was found in 12 (44.4%) children: 9/18 (50.0%) with hypertension and 3/9 (33.3%) with normal BP. Systolic,
diastolic, mean blood pressure and diastolic blood pressure load correlated with neutrophil count, neutrophilto-
lymphocyte ratio and platelet-to-lymphocyte ratio (r = 0.39–0.49, p = 0.010–0.044); diastolic and mean blood
pressure and diastolic blood pressure load with parathormone (r = 0.48–0.57, p = 0.005–0.023); diastolic blood
pressure load with phosphate and calcium-phosphorus product (r = 0.44–0.47, p = 0.021-0.030); diastolic blood
pressure dipping with phosphate (r = –0.43, p = 0.034).
Conclusions. 1. Ambulatory blood pressure monitoring should be used in children with chronic kidney disease on a
regular basis, especially in those with arterial hypertension. 2. Blood pressure in children with chronic kidney disease
may be related to degree of subclinical inflammation.
Keywords: childrenchronic kidney diseasehypertensionambulatory blood pressure monitoringinflammation
References
- Mitsnefes MM. Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol. 2012; 23(4): 578–585.
- Flynn JT, Daniels SR, Hayman LL, et al. American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014; 63(5): 1116–1135.
- Li Y, Wang JG, Dolan E, et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension. 2006; 47(3): 359–364.
- Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015; 39(1-3): 84–92.
- Sunbul M, Gerin F, Durmus E, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. 2014; 36(4): 217–221.
- Binnetoğlu E, Şengül E, Halhallı G, et al. Is neutrophil lymphocyte ratio an indicator for proteinuria in chronic kidney disease? J Clin Lab Anal. 2014; 28(6): 487–492.
- Ahbap E, Sakaci T, Kara E. Serum uric acid levels and inflammatory markers with respect to dipping status: a retrospective analysis of hypertensive patients with or without chronic kidney disease. Clin Exp Hypertens. 2016; 38 (6): 555–563.
- Endler G, Klimesch A, Sunder-Plassmann H, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol. 2002; 117(2): 399–404.
- Nadar SK, Blann AD, Kamath S, et al. Platelet indexes in relation to target organ damage in high-risk hypertensive patients: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). J Am Coll Cardiol. 2004; 44(2): 415–422.
- Tangvarasittichai S, Pingmuanglaew P, Tangvarasittichai O. Association of Elevated Serum Lipoprotein(a), Inflammation, Oxidative Stress and Chronic Kidney Disease with Hypertension in Non-diabetes Hypertensive Patients. Indian J Clin Biochem. 2016; 31(4): 446–451.
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. . KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013; 3(1): 1–150.
- Schwartz GJ, Muñoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009; 20(3): 629–637.
- Kułaga Z, Litwin M, Tkaczyk M, et al. Polish 2010 growth references for school-aged children and adolescents. Eur J Pediatr. 2011; 170(5): 599–609.
- Litwin M, Niemirska A, Obrycki Ł, et al. Guidelines of the Pediatric Section of the Polish Society of Hypertension on diagnosis and treatment of arterial hypertension in children and adolescents. Arterial Hypertension. 2018; 22(2): 45–73.
- Kułaga Z, Litwin M, Grajda A, et al. OLAF Study Group. Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents. J Hypertens. 2012; 30(10): 1942–1954.
- Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012; 2(4): 288–335.
- Klaus G, Watson A, Edefonti A, et al. European Pediatric Dialysis Working Group (EPDWG). Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines. Pediatr Nephrol. 2006; 21(2): 151–159.
- Rusińska A, Płudowski P, Walczak M, et al. Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland — Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies-2018 Update. Front Endocrinol (Lausanne). 2018; 9: 246.
- Samuels J, Ng D, Flynn JT, et al. Chronic Kidney Disease in Children Study Group. Ambulatory blood pressure patterns in children with chronic kidney disease. Hypertension. 2012; 60(1): 43–50.
- Stabouli S, Kotsis V, Toumanidis S. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol. 2005; 20(8): 1151–1155.
- Mitsnefes M, Flynn J, Cohn S, et al. CKiD Study Group. Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol. 2010; 21(1): 137–144.
- Mitsnefes MM, Kimball TR, Daniels SR. Office and ambulatory blood pressure elevation in children with chronic renal failure. Pediatr Nephrol. 2003; 18(2): 145–149.
- Belsha CW, Wells TG, McNiece KL, et al. Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens. 1998; 11(4 Pt 1): 410–417.
- Tsioufis C, Andrikou I, Thomopoulos C, et al. Comparative prognostic role of nighttime blood pressure and nondipping profile on renal outcomes. Am J Nephrol. 2011; 33(3): 277–288.
- Taymez DG, Ucar E, Turkmen K, et al. The predictive value of platelet/lymphocyte ratio in hemodialysis patients with erythropoietin resistance. Ther Apher Dial. 2016; 20(2): 118–121.
- Yaprak M, Turan MN, Dayanan R, et al. Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients. Int Urol Nephrol. 2016; 48(8): 1343–1348.
- Shroff R. Phosphate is a vascular toxin. Pediatr Nephrol. 2013; 28(4): 583–593.
- Vyssoulis G, Karpanou E, Tzamou V, et al. Serum phosphate in white-coat hypertensive patients: focus on dipping status and metabolic syndrome. Hypertens Res. 2010; 33(8): 825–830.
- Icardi A, Paoletti E, De Nicola L, et al. Renal anaemia and EPO hyporesponsiveness associated with vitamin D deficiency: the potential role of inflammation. Nephrol Dial Transplant. 2013; 28(7): 1672–1679.
- Isakova T, Gutiérrez OM, Patel NM, et al. Vitamin D deficiency, inflammation, and albuminuria in chronic kidney disease: complex interactions. J Ren Nutr. 2011; 21(4): 295–302.
- Donate-Correa J, Domínguez-Pimentel V, Méndez-Pérez ML, et al. Selective vitamin D receptor activation as anti-inflammatory target in chronic kidney disease. Mediators Inflamm. 2014; 2014: 670475.
- Sinha MD, Keehn L, Milne L, et al. Decreased arterial elasticity in children with nondialysis chronic kidney disease is related to blood pressure and not to glomerular filtration rate. Hypertension. 2015; 66(4): 809–815.
- Patange AR, Valentini RP, Du W, et al. Vitamin D deficiency and arterial wall stiffness in children with chronic kidney disease. Pediatr Cardiol. 2012; 33(1): 122–128.