Katsoufis Chryso P, Seeherunvong Wacharee, Sasaki Nao, Abitbol Carolyn L, Chandar Jayanthi, Freundlich Michael, Zilleruelo Gaston E
Division of Pediatric Nephrology, Department of Pediatrics , University of Miami , Miami, FL , USA.
Division of Pediatric Cardiology, Department of Pediatrics , University of Miami , Miami, FL , USA.
Clin Kidney J. 2014 Feb;7(1):33-9. doi: 10.1093/ckj/sft149. Epub 2013 Dec 23.
Children undergoing chronic hemodialysis are at risk of cardiovascular disease and often develop left ventricular hypertrophy (LVH). Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is known to better predict cardiovascular morbidity than casual blood pressure (BP) measurement. Given the BP variability attributed to interdialytic fluid overload, 44-h ABPM should better delineate cardiovascular morbidity in pediatric hemodialysis patients.
In this cross-sectional study, 17 children (16.7 ± 2.9 years) on chronic hemodialysis underwent 44-h interdialytic ABPM and routine echocardiogram. Left ventricular mass index (LVMI) was calculated by height-based equation; LVH was defined as an LVMI in the ≥95th percentile for height-age and gender. Hypertension was defined by the recommendations of the Fourth Report of the National High Blood Pressure Education Program for casual measurements, and by those of the American Heart Association for ABPM.
Twenty-four percentage of patients were hypertensive by casual post-dialytic systolic BP, whereas 59% were hypertensive by ABPM. Eighty-eight percentage of patients had abnormal cardiac geometry: 53% had LVH. Thirty-five percentage (6 of 17) had masked hypertension, including four with abnormal cardiac geometry, of which, three had LVH. LVMI correlated with ABPM, but not with casual measurements. Strongest correlations with an increased LVMI were with 44-h diastolic BP: at night (r = 0.53, P = 0.03) and total load (r = 0.57, P = 0.02). LVH was similarly associated with 44-h nighttime BP: systolic (P = 0.02), diastolic (P = 0.01) and mean arterial (P = 0.01).
Casual BP measurement underestimates hypertension in pediatric hemodialysis patients and does not correlate well with indicators of cardiovascular morbidity. In contrast, 44-h interdialytic ABPM better characterizes hypertension, with nighttime parameters most strongly predicting increased LVMI and LVH.
接受慢性血液透析的儿童有患心血管疾病的风险，且常出现左心室肥厚（LVH）。已知24小时动态血压监测（ABPM）比偶然血压（BP）测量能更好地预测心血管疾病的发病率。鉴于透析间期液体过载导致的血压变异性，44小时ABPM应能更好地描述儿科血液透析患者的心血管疾病发病率。
在这项横断面研究中，17名接受慢性血液透析的儿童（16.7±2.9岁）接受了44小时的透析间期ABPM和常规超声心动图检查。左心室质量指数（LVMI）通过基于身高的公式计算；LVH定义为身高年龄和性别的LVMI在第95百分位及以上。高血压根据《国家高血压教育计划第四次报告》中关于偶然测量的建议以及美国心脏协会关于ABPM的建议来定义。
24%的患者透析后偶然收缩压高血压，而ABPM显示59%的患者高血压。88%的患者心脏几何形状异常：53%有LVH。35%（17名中的6名）有隐匿性高血压，其中4名心脏几何形状异常，3名有LVH。LVMI与ABPM相关，但与偶然测量无关。与LVMI增加相关性最强的是44小时舒张压：夜间（r = 0.53，P = 0.03）和总负荷（r = 0.57，P = 0.02）。LVH同样与44小时夜间血压相关：收缩压（P = 0.02）、舒张压（P = 0.01）和平均动脉压（P = 0.01）。
偶然血压测量低估了儿科血液透析患者的高血压情况，且与心血管疾病发病率指标相关性不佳。相比之下，44小时透析间期ABPM能更好地表征高血压，夜间参数预测LVMI增加和LVH的能力最强。
