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44-h ambulatory blood pressure monitoring: revealing the true burden of hypertension in pediatric hemodialysis patients

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Abstract

Background

The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM.

Methods

ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI).

Results

A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of ≥25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load.

Conclusions

The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram.

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Acknowledgments

This work is supported by the Stanford CTSA (UL1 RR025744) “The Paul and Yuanbi Ramsay Endowed Postdoctoral Fellow”.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Stanford University, 300 Pasteur Drive, Room G306, Stanford, CA, 94305-5208, USA

    Orly Haskin, Cynthia J. Wong, Scott M. Sutherland & Abanti Chaudhuri

  2. Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA

    Lonisa McCabe & Brandy Begin

Authors
  1. Orly Haskin
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  2. Cynthia J. Wong
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  3. Lonisa McCabe
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  4. Brandy Begin
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  5. Scott M. Sutherland
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  6. Abanti Chaudhuri
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Correspondence to Abanti Chaudhuri.

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Haskin, O., Wong, C.J., McCabe, L. et al. 44-h ambulatory blood pressure monitoring: revealing the true burden of hypertension in pediatric hemodialysis patients. Pediatr Nephrol 30, 653–660 (2015). https://doi.org/10.1007/s00467-014-2964-7

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  • DOI: https://doi.org/10.1007/s00467-014-2964-7

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