Nocturnal Dipping and Kidney Function Decline: Findings From the CKD in Children Study

Christine Y Bakhoum, Manali Phadke, Yanhong Deng, Joshua A Samuels, Pranav S Garimella, Susan L Furth, F Perry Wilson, Joachim H Ix, Christine Y Bakhoum, Manali Phadke, Yanhong Deng, Joshua A Samuels, Pranav S Garimella, Susan L Furth, F Perry Wilson, Joachim H Ix

Abstract

Introduction: Normally, blood pressure (BP) declines by at least 10% from daytime to nighttime. In adults, blunted nocturnal dipping has been associated with more rapid decline in kidney function. Nondipping is prevalent in children with chronic kidney disease (CKD). We sought to determine whether nondipping is associated with proteinuria and progression to kidney failure in children with CKD.

Methods: In the prospective CKD in children (CKiD) cohort, Cox proportional hazards models were used to evaluate the relationship between baseline nondipping and progression to kidney failure. Linear mixed effects models were used to evaluate the relationship between nondipping and changes in iohexol glomerular filtration rate (GFR) and urine protein-to-creatinine ratio (log-UPCR, mg/mg) over time.

Results: Among 620 participants, mean age was 11 (± 4) years, mean iohexol GFR was 52 (± 22) ml/min per 1.73 m2, and 40% were nondippers at baseline. There were 169 kidney failure events during 2.9 years (median) of follow-up. Dipping status was not significantly associated with kidney failure overall (hazard ratio [HR] 1.08; 95% confidence interval [CI] 0.77, 1.51) or in those with (HR 1.21; 95% CI 0.53, 2.77) or without (HR 1.05; 95% CI 0.71, 1.55) glomerular disease. Dipping status did not modify the relationship between time and change in iohexol GFR or log (UPCR) from baseline (interaction P values = 0.20 and 0.054, respectively).

Conclusion: Nondipping is not associated with end-stage kidney disease, GFR decline, or change in proteinuria within the CKiD cohort.

Keywords: blood pressure; children; chronic kidney disease; dipping; hypertension; pediatrics.

© 2022 International Society of Nephrology. Published by Elsevier Inc.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Kidney failure-free survival by dipping status in participants with (a) nonglomerular CKD and (b) glomerular CKD. Nondippers are represented in red and dippers in blue. Shading represents 95% confidence interval. Log-rank P values presented for difference in kidney failure-free survival between groups. ESKD, end-stage kidney disease.

References

    1. Kanbay M., Turgut F., Uyar M.E., Akcay A., Covic A. Causes and mechanisms of nondipping hypertension. Hypertens. 2008;30:585–597. doi: 10.1080/10641960802251974.
    1. Biaggioni I. Circadian clocks, autonomic rhythms, and blood pressure dipping. Hypertension. 2008;52:797–798. doi: 10.1161/HYPERTENSIONAHA.108.117234.
    1. Flynn J.T., Daniels S.R., Hayman L.L., et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63:1116–1135. doi: 10.1161/hyp.0000000000000007.
    1. Yano Y., Kario K. Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens Res. 2012;35:695–701. doi: 10.1038/hr.2012.26.
    1. Davidson M.B., Hix J.K., Vidt D.G., Brotman D.J. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Arch Intern Med. 2006;166:846–852. doi: 10.1001/archinte.166.8.846.
    1. Afsar B., Elsurer R. Urinary albumin excretion among nondipper hypertensive patients is closely related with the pattern of nondipping. J Am Soc Hypertens. 2010;4:196–202. doi: 10.1016/j.jash.2010.06.004.
    1. Hoshide S., Kario K., Hoshide Y., et al. Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives. Am J Hypertens. 2003;16:434–438. doi: 10.1016/s0895-7061(03)00567-3.
    1. Abdalla M., Caughey M.C., Tanner R.M., et al. Associations of blood pressure dipping patterns with left ventricular mass and left ventricular hypertrophy in blacks: the Jackson heart study. J Am Heart Assoc. 2017;6:e004847. doi: 10.1161/jaha.116.004847.
    1. Mitsnefes M., Flynn J., Cohn S., et al. Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol. 2010;21:137–144. doi: 10.1681/ASN.2009060609.
    1. Warady B.A., Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol. 2007;22:1999–2009. doi: 10.1007/s00467-006-0410-1.
    1. Wilson A.C., Flynn J.T. Blood pressure in children with chronic kidney disease: lessons learned from the chronic kidney disease in children cohort study. Pediatr Nephrol. 2020;35:1203–1209. doi: 10.1007/s00467-019-04288-6.
    1. Bakhoum C.Y., Katz R., Samuels J.A., et al. Nocturnal dipping and left ventricular mass index in the chronic kidney disease in children cohort. Clin J Am Soc Nephrol. 2022;17:75–82. doi: 10.2215/cjn.09810721.
    1. Furth S.L., Cole S.R., Moxey-Mims M., et al. Design and methods of the chronic kidney disease in children (CKiD) prospective cohort study. Clin J Am Soc Nephrol. 2006;1:1006–1015. doi: 10.2215/cjn.01941205.
    1. Atkinson M.A., Ng D.K., Warady B.A., Furth S.L., Flynn J.T. The CKiD study: overview and summary of findings related to kidney disease progression. Pediatr Nephrol. 2020;36:527–538. doi: 10.1007/s00467-019-04458-6.
    1. Samuels J., Ng D., Flynn J.T., et al. Ambulatory blood pressure patterns in children with chronic kidney disease. Hypertension. 2012;60:43–50. doi: 10.1161/HYPERTENSIONAHA.111.189266.
    1. Schwartz G.J., Abraham A.G., Furth S.L., Warady B.A., Muñoz A. Optimizing iohexol plasma disappearance curves to measure the glomerular filtration rate in children with chronic kidney disease. Kidney Int. 2010;77:65–71. doi: 10.1038/ki.2009.398.
    1. Furth S.L., Pierce C., Hui W.F., et al. Estimating time to ESRD in children with CKD. Am J Kidney Dis. 2018;71:783–792. doi: 10.1053/j.ajkd.2017.12.011.
    1. Cuspidi C., Giudici V., Negri F., Sala C. Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review. Expert Rev Cardiovasc Ther. 2010;8:781–792. doi: 10.1586/erc.10.29.
    1. Agarwal R., Light R.P. GFR, proteinuria and circadian blood pressure. Nephrol Dial Transplant. 2009;24:2400–2406. doi: 10.1093/ndt/gfp074.
    1. Choi H.Y., Lee C.J., Lee J.E., et al. Loss of nighttime blood pressure dipping as a risk factor for coronary artery calcification in nondialysis chronic kidney disease. Medicine (Baltimore) 2017;96:e7380. doi: 10.1097/md.0000000000007380.
    1. Rahman M., Griffin V., Heyka R., Hoit B. Diurnal variation of blood pressure; reproducibility and association with left ventricular hypertrophy in hemodialysis patients. Blood Press Monit. 2005;10:25–32. doi: 10.1097/00126097-200502000-00006.
    1. Zhao P., Xu P., Wan C., Wang Z. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev. 2011;2011:Cd004184. doi: 10.1002/14651858.CD004184.pub2.
    1. Bowles N.P., Thosar S.S., Herzig M.X., Shea S.A. Chronotherapy for hypertension. Curr Hypertens Rep. 2018;20:97. doi: 10.1007/s11906-018-0897-4.
    1. Mitsnefes M.M., Kimball T.R., Daniels S.R. Office and ambulatory blood pressure elevation in children with chronic renal failure. Pediatr Nephrol. 2003;18:145–149. doi: 10.1007/s00467-002-1030-z.
    1. Lovshin J.A., Škrtić M., Bjornstad P., et al. Hyperfiltration, urinary albumin excretion, and ambulatory blood pressure in adolescents with type 1 diabetes mellitus. Am J Physiol Ren Physiol. 2018;314:F667–F674. doi: 10.1152/ajprenal.00400.2017.
    1. Bakhoum C.Y., Vuong K.T., Carter C.E., Gabbai F.B., Ix J.H., Garimella P.S. Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents. Pediatr Res. 2021;90:876–881. doi: 10.1038/s41390-020-01315-3.
    1. Correia-Costa A., Correia-Costa L., Caldas Afonso A., et al. Determinants of carotid-femoral pulse wave velocity in prepubertal children. Int J Cardiol. 2016;218:37–42. doi: 10.1016/j.ijcard.2016.05.060.
    1. Chang J.C., Xiao R., Meyers K.E., et al. Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus. Arthritis Res Ther. 2020;22:129. doi: 10.1186/s13075-020-02224-w.
    1. Viera A.J., Lin F.C., Hinderliter A.L., et al. Nighttime blood pressure dipping in young adults and coronary artery calcium 10–15 years later: the coronary artery risk development in young adults study. Hypertension. 2012;59:1157–1163. doi: 10.1161/hypertensionaha.112.191536.
    1. Stergiou G.S., Bountzona I., Alamara C., Vazeou A., Kollias A., Ntineri A. Reproducibility of office and out-of-office blood pressure measurements in children: implications for clinical practice and research. Hypertension. 2021;77:993–1000. doi: 10.1161/HYPERTENSIONAHA.120.16531.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel