Daytime, nocturnal hypertension pose risk of kidney replacement therapy in kids with CKD

Paediatric chronic kidney disease (CKD) patients with both daytime and nocturnal hypertension are at high risk of progressing to kidney replacement therapy, according to a study.

Researchers examined 1,577 ambulatory blood pressure monitoring studies from 701 children. They used Cox proportional hazards models to assess nocturnal, daytime, or sustained hypertension in relation to progression to kidney replacement therapy. Nocturnal and diurnal hypertension were defined as mean blood pressure >95th percentile and/or load >25 percent for either systolic or diastolic blood pressure within sleep or wake periods.

Of the children, 19 percent had nocturnal hypertension, 7 percent had daytime hypertension, and 33 percent had both types. Those with both daytime and nocturnal hypertension had the highest risk of kidney replacement therapy.

Among children with CKD, the presence of both daytime and nocturnal hypertension upped the risk of progression to kidney replacement therapy by more than twofold relative to normotension (hazard ratio [HR], 2.23, 95 percent confidence interval [CI], 1.60–3.11; p<0.001). Meanwhile, the risk estimate associated with isolated nocturnal hypertension was lower (HR, 1.49, 95 percent CI, 0.97–2.28; p=0.068).

Results were consistent among glomerular and nonglomerular participants, although the association in the former group failed to reach statistical significance due to smaller sample size.

The present data underscore the importance of ambulatory blood pressure monitoring in children with CKD, such that identifying and controlling both daytime and nocturnal hypertension using ambulatory blood pressure monitoring may improve outcomes and delay CKD progression in this population.