Blood pressure control and left ventricular mass in children with chronic kidney disease.
OBJECTIVE
Heart disease is a major cause of death in young adults with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is common and is associated with hypertension. The aims of this study were to evaluate whether there is a relationship between LVH and BP in children with CKD and whether current targets for BP control are appropriate.


METHODS
In this single-center cross-sectional study, 49 nonhypertensive children, (12.6 ± 3.0 years, mean GFR 26.1 ± 12.9 ml/min per 1.73 m²) underwent echocardiographic evaluation and clinic and 24-hour ambulatory BP monitoring. LVH was defined using age-specific reference intervals for left ventricular mass index (LVMI). Biochemical data and clinic BP for 18 months preceding study entry were also analyzed.


RESULTS
The mean LVMI was 37.8 ± 9.1 g/m²·⁷, with 24 children (49%) exhibiting LVH. Clinic BP values were stable over the 18 months preceding echocardiography. Patients with LVH had consistently higher BP values than those without, although none were overtly hypertensive (> 95th percentile). Multiple linear regression demonstrated a strong relationship between systolic BP and LVMI. Clinic systolic BP showed a stronger relationship than ambulatory measures. Of the confounders evaluated, only elemental calcium intake yielded a consistent, positive relationship with LVMI.


CONCLUSIONS
LVMI was associated with systolic BP in the absence of overt hypertension, suggesting that current targets for BP control should be re-evaluated. The association of LVMI with elemental calcium intake questions the appropriateness of calcium-based phosphate binders in this population.
Department of Pediatric Nephrology, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, UK. manish.sinha@gstt.nhs.uk
Manish D
MD
Sinha
Shane M
SM
Tibby
Pernille
P
Rasmussen
Debbie
D
Rawlins
Charles
C
Turner
R Neil
RN
Dalton
Christopher J D
CJ
Reid
Susan P A
SP
Rigden
Caroline J
CJ
Booth
John M
JM
Simpson
D000293:Adolescent; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002118:Calcium / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000009:adverse effects; D015150:Echocardiography, Doppler; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology*; D007674:Kidney Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016014:Linear Models; D008131:London; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D002118:Calcium