ESPN 50th Annual Meeting

ESPN 2017

Ambulatory hypertension and left ventricular hypertrophy in dialyzed children: Does dialysis modality matter?
Giulio Nobile 1 Dagmara Borzych-Duzalka 2 Laura Benner 3 Rukshana Shroff 4 Hong Xu 5 Erkin Serdaroglu 6 Yap Hui kim 7 Karel Vondrak 8 Nakysa Hooman 9 Lale Sever 10 Emilija Sahpazova 11 Dorota Drozdz 12 Divina Kruscic 13 Constantinos Stefanidis 14 Maria Szczepańska 15 Rainer Buescher 16 Claus P. Schmitt 1 Bradley Warady 17 Franz Schaefer 1

1- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
2- Division for Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Poland
3- Institut für Medizinische Biometrie und Informatik, Heidelberg, Germany
4- Great Ormond Street Hospital, London, United Kingdom.
5- Childrens Hospital of Fudan University, Shanghai, China
6- Dr.Behcet Uz Children Research and Education Hospital, Izmir, Turkey
7- Shaw-NKF-NUH Childrens Kidney Centre, Singapore
8- University Hospital Motol, Prague, Czech Republic
9- Iran University of Medical Sciences, Teharan, Iran
10- Cerrahpasa School of Medicine, Istanbul, Turkey
11- Pediatric Clinic, Nephrology Unit, Skopje, Macedonia
12- Jagiellonian University Medical College, Krakow, Poland
13- University Childrens Hospital, Belgrade, Serbia
14- A&P Kyriakou Childrens Hospital, Athens, Greece
15- Chair and Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
16- Universitäts-Kinderklinik Essen, Essen, Germany
17- Childrens Mercy Hospital, Kansas City, USA

To compare 24-hour blood pressure and left ventricular mass in children on different peritoneal and extracorporeal dialysis modalities. 


Material and methods:


Prospective registry study of 579 paediatric patients undergoing chronic dialysis (121 CAPD, 327 Automated (A)PD, 91 HD, 40 HDF) in whom 1,277 ABPM profiles were performed. 905 echocardiography studies were available in 451 patients. Generalized linear modeling was applied to identify factors affecting 24h-MAP and left ventricular mass index (LVMI).  


At study entry, 24h-MAP SDS differed significantly between HD (2.9±3.7 SDS), HDF (1.3±1.9), APD  (2.1±3.6) and CAPD patients (0.9±3.7). Differences were explained by variation in daytime MAP. Nighttime MAP was more markedly elevated than daytime MAP (night: 2.1±2.5 vs. day: 1.3±3.1 SDS) and not different across treatment modalities. Nocturnal dipping was reduced (<10%) in 49% and even reversed in another 13.4% of patients, without differences between the treatment groups. Median (iqr) LVMI was lower in HDF (40.6 (20.3) g/m2.16) than in all other treatment groups (medians 43.5-45.9 g/m2.16; p=0.022).

In the multivariable longitudinal analysis, 24h-MAP increased with age (0.5±0.1 mmHg/year;p<.001), decreased by 5.0±0.9 mmHg per L/m2 daily urine output (p<.001) and was 5.2±1.9 mmHg higher in HD than in CAPD patients (p=0.007). 24-MAP did not change with time on dialysis. Higher MAP was associated with the use of Ca-channel blockers (+4.6±1.1 mmHg,p<.001) and beta-blockers  (+2.7±1.2 mmHg,p=0.027). Nocturnal dipping was greater in patients with preserved urine output and higher with APD and HDF than with CAPD. LVMI increased with 24h-MAP (+0.32±0.04 g/m2.16 per mmHg, p<.001), BMI (+3.1±0.7 g/m2.16 per SD,p<.001) and diminishing urine output (-3.2±1.6 g/m2.16 per L/m2/d, p=0.049), and was higher in CAPD than in APD (-10±2.5 mmHg, p<.001), HD (-9.2±3.5, p=0.008) and HDF (-12.9±4.2, p=0.002).




After multivariate adjustment HD associates with higher 24h-MAP, and CAPD with lower nocturnal dipping and higher LV mass.