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Association of blood pressure variability and neurocognition in children with chronic kidney disease

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Abstract

Background

Children with chronic kidney disease (CKD) and hypertension have increased blood pressure variability (BPV), which has been associated with lower neurocognitive test scores in adults. Children with CKD are at risk for decreased neurocognitive function. Our objective was to determine whether children with CKD and increased BPV had worse performance on neurocognitive testing compared with children with CKD and lower BPV.

Methods

This was a cross-sectional and longitudinal analysis of the relation between BPV and neurocognitive test performance in children ≥6 years enrolled in the Chronic Kidney Disease in Children (CKiD) study. Visit-to-visit BPV was assessed by the standard deviation of visit BPs (BPV-SD) and average real variability (ARV). Ambulatory BPV was assessed by SD of wake and sleep periods on 24-h ambulatory BP monitoring.

Results

We assessed 650 children with a mean follow-up period of 4.0 years. Children with systolic visit-to-visit BPV in the upper tertile had lower scores on Delis–Kaplan Executive Function System (D-KEFS) Verbal Category Switching than those with BPV in the lower tertile (BPV-SD, 8.3 vs. 9.5, p = 0.006; ARV, 8.5 vs. 9.6, p = 0.02). On multivariate analysis, the association between lower Category Switching score and increased BPV remained significant after controlling for mean BP, demographic characteristics, and disease-related variables [BPV-SD, β = −0.7, 95 % confidence interval (CI) −1.28 to −0.12; ARV, β = −0.54, CI −1.05 to −0.02). Ambulatory BPV was not independently associated with any cognitive measure.

Conclusions

Higher systolic visit-to-visit BPV was independently associated with decreased D-KEFS Category Switching scores in children with mild-to-moderate 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 (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01DK-082194, U01-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid

This work was presented in abstract form at the American Society of Nephrology Kidney Week 2015.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave., Box 777, Rochester, NY, 14642, USA

    Marc B. Lande

  2. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA

    Susan R. Mendley

  3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Matthew B. Matheson

  4. Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Shlomo Shinnar

  5. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Arlene C. Gerson

  6. Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA

    Joshua A. Samuels

  7. Division of Nephrology, Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley A. Warady

  8. Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan L. Furth

  9. Departments of Allied Health Sciences and Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Stephen R. Hooper

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  1. Marc B. Lande
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  2. Susan R. Mendley
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  4. Shlomo Shinnar
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  5. Arlene C. Gerson
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  6. Joshua A. Samuels
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  7. Bradley A. Warady
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  9. Stephen R. Hooper
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Corresponding author

Correspondence to Marc B. Lande.

Ethics declarations

The study protocol was approved by the Institutional Review Boards and informed consent was obtained at each participating center from all individual participants included in the study. The research activities being reported here adhere to the Declaration of Helsinki.

Conflict of interest

The authors report that they have no conflict of interest.

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Lande, M.B., Mendley, S.R., Matheson, M.B. et al. Association of blood pressure variability and neurocognition in children with chronic kidney disease. Pediatr Nephrol 31, 2137–2144 (2016). https://doi.org/10.1007/s00467-016-3425-2

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  • DOI: https://doi.org/10.1007/s00467-016-3425-2

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