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Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study

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Abstract

Background

Autonomic nervous system dysfunction and sympathetic nervous system over-activity play important roles in the development of hypertension associated with chronic kidney disease (CKD). In adults, increased blood pressure variability (BPV) appears to be directly related to sympathetic over-activity with increased risk of end-organ damage and cardiovascular events. Decreased heart rate variability (HRV) has been observed in adults with CKD, and is an independent predictor of mortality.

Methods

The purpose of this study was to evaluate BPV and HRV in pediatric patients enrolled in the Chronic Kidney Disease in Children Study. Ambulatory blood pressure monitoring data were available for analysis of 215 person-visits from 144 children that were not receiving antihypertensive medications.

Results

BPV and HRV were determined by standard deviation and coefficient of variation for heart rate and systolic and diastolic blood pressure for each patient averaged for wake/sleep periods during 24-h monitoring. Uniformly lower values were displayed during sleep versus wake periods: BPV was 20 % lower during sleep (p < 0.001) and HRV was 30 % lower during sleep (p < 0.001). A significant increase in systolic BPV was observed in hypertensive children compared to children with normal blood pressure (6.9 %, p = 0.009). Increased diastolic BPV was detected among hypertensive children during sleep period compared to children with normal blood pressure (11.5 %, p = 0.008). There was a significant decrease in HRV in hypertensive compared to normotensive children (−8.2 %, p = 0.006).

Conclusions

These findings are similar to those in adult patients and may underscore childhood origin and natural progression of adverse cardiovascular outcomes in adults with CKD.

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Acknowledgments

Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri–Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia and the University of Pennsylvania (Susan Furth, MD, Ph.D.), a Central Biochemistry Laboratory at the University of Rochester (George Schwartz, MD), and a data coordinating center at the Johns Hopkins Bloomberg School of Public Health (Alvaro Muñoz, Ph.D.). The CKiD prospective cohort study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the National Institute of Neurological Disorders and Stroke, the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (UO1-DK-66143, UO1-DK-66174, UO1-DK-082194, UO1-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid.

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Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplantation, Phoenix Children’s Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA

    Gina-Marie Barletta

  2. Seattle Children’s Hospital, Seattle, WA, USA

    Joseph Flynn

  3. Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Mark Mitsnefes

  4. University of Texas, Houston, TX, USA

    Joshua Samuels & Timothy Poffenbarger

  5. John’s Hopkins, Baltimore, MD, USA

    Lisa Aronson Friedman, Derek Ng & Christopher Cox

  6. Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley Warady

  7. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan Furth

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  1. Gina-Marie Barletta
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Correspondence to Gina-Marie Barletta.

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Barletta, GM., Flynn, J., Mitsnefes, M. et al. Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study. Pediatr Nephrol 29, 1059–1065 (2014). https://doi.org/10.1007/s00467-013-2737-8

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  • DOI: https://doi.org/10.1007/s00467-013-2737-8

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