Ambulatory blood pressure monitoring and subclinical inflammation in children with chronic kidney disease

Background. Children with chronic kidney disease (CKD) are characterized by increased risk of hypertension andchronic low-grade inflammation. The aim of the study was the analysis of relation between parameters of ambulatoryblood pressure monitoring (ABPM) and subclinical inflammation in children with CKD. Material and methods. Study group included 27 paediatric patients (age 14.23 ± 3.57 years) with CKD stage 2–5;18 children with previously recognized hypertension. In all patients we evaluated ABPM, office blood pressure,complete blood count and selected clinical and biochemical parameters. Results. In the study group, GFR was from 7.05 to 86.73, mean 40.88 ± 25.82 mL/min/1.73 m2. All 9 childrenwithout hypertension had normal blood pressure in ABPM, but ABPM detected poor blood pressure control in 7among 18 (38.9%) children with previously recognized and treated hypertension. Abnormal circadian blood pressureprofile was found in 12 (44.4%) children: 9/18 (50.0%) with hypertension and 3/9 (33.3%) with normal BP. Systolic,diastolic, mean blood pressure and diastolic blood pressure load correlated with neutrophil count, neutrophilto-lymphocyte ratio and platelet-to-lymphocyte ratio (r = 0.39–0.49, p = 0.010–0.044); diastolic and mean bloodpressure and diastolic blood pressure load with parathormone (r = 0.48–0.57, p = 0.005–0.023); diastolic bloodpressure load with phosphate and calcium-phosphorus product (r = 0.44–0.47, p = 0.021-0.030); diastolic bloodpressure dipping with phosphate (r = –0.43, p = 0.034). Conclusions. 1. Ambulatory blood pressure monitoring should be used in children with chronic kidney disease on aregular basis, especially in those with arterial hypertension. 2. Blood pressure in children with chronic kidney diseasemay be related to degree of subclinical inflammation

Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years

Introduction : We evaluated outcomes in children with chronic kidney disease stage 5 (CKD 5) treated in the first pediatric dialysis unit in Poland during 1973-2012. Material and methods: The retrospective analysis included 208 children with CKD 5 undergoing renal replacement therapy (RRT), stratified into four decades of treatment: 1973–1982, 1983–1992, 1993–2002, and 2003–2012. Results : The most common causes of CKD 5 included glomerulonephritis in 27.4% and pyelonephritis secondary to urinary tract anomalies in 25.5% of children. Among 208 children, 172 (82.7%) survived and 17.3% died. Kidney transplantation (KTx) was performed in 47.6% of children, including pre-emptive KTx in 1.92% of children. Chronic dialysis was continued in 34.1% of children, and RRT was withdrawn in 1%. The overall mortality rate was 6.2 per 100 patient-years, and 3-year survival was 83.9%. The highest mortality rate of 23.4 per 100 patient-years was observed among children in whom RRT was initiated in 1973–1982, with subsequent reduction of the mortality rate to 4.5 and 2.1 per 100 patient-years in 1993–2002 and 1983–1992 respectively. No deaths were noted after 2002. Cardiovascular problems were the most common cause of death, found in 36.1% of patients (p < 0.01). Identified risk factors for mortality included young age, low residual diuresis, anemia at the time of RRT initiation, and hypertriglyceridemia and hypoalbuminemia during RRT. Conclusions : In years 1973–2012 significant improvement in prognosis among children with CKD 5 was achieved. Identified predictors of mortality included young age at initiation of RRT, low residual diuresis, anemia and hypertriglyceridemia