儿童慢性肾脏病队列中的夜间血压下降与左心室质量指数。
Nocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort.
机构信息
Department of Pediatrics, Section of Pediatric Nephrology, Yale University, New Haven, Connecticut.
Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
出版信息
Clin J Am Soc Nephrol. 2022 Jan;17(1):75-82. doi: 10.2215/CJN.09810721. Epub 2021 Nov 12.
BACKGROUND AND OBJECTIVES
The physiologic nocturnal BP decline is often blunted in patients with CKD; however, the consequences of BP nondipping in children are largely unknown. Our objective was to determine risk factors for nondipping and to investigate if nondipping is associated with higher left ventricular mass index in children with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a cross-sectional analysis of ambulatory BP monitoring and echocardiographic data in participants of the Chronic Kidney Disease in Children study. Multivariable linear and spline regression analyses were used to evaluate the relationship of risk factors with dipping and of dipping with left ventricular mass index.
RESULTS
Within 552 participants, mean age was 11 (±4) years, mean eGFR was 53 (±20) ml/min per 1.73 m, and 41% were classified as nondippers. In participants with nonglomerular CKD, female sex and higher sodium intake were significantly associated with less systolic and diastolic dipping (≤0.05). In those with glomerular CKD, Black race and greater proteinuria were significantly associated with less systolic and diastolic dipping (≤0.05). Systolic dipping and diastolic dipping were not significantly associated with left ventricular mass index; however, in spline regression plots, diastolic dipping appeared to have a nonlinear relationship with left ventricular mass index. As compared with diastolic dipping of 20%-25%, dipping of <20% was associated with 1.41-g/m-higher left ventricular mass index (95% confidence interval, -0.47 to 3.29), and dipping of >25% was associated with 1.98-g/m-higher left ventricular mass index (95% confidence interval, -0.77 to 4.73), although these relationships did not achieve statistical significance.
CONCLUSIONS
Black race, female sex, and greater proteinuria and sodium intake were significantly associated with blunted dipping in children with CKD. We did not find a statistically significant association between dipping and left ventricular mass index.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_12_20_CJN09810721.mp3.
背景和目的
慢性肾脏病（CKD）患者的夜间血压生理性下降通常减弱；然而，血压非杓型在儿童中的后果在很大程度上仍不清楚。我们的目的是确定非杓型的危险因素，并研究 CKD 患儿的非杓型与更高的左心室质量指数（LVMI）之间是否存在关联。
设计、设置、参与者和测量：我们对慢性肾脏病儿童研究中的动态血压监测和超声心动图数据进行了横断面分析。多变量线性和样条回归分析用于评估危险因素与杓型的关系，以及杓型与左心室质量指数的关系。
结果
在 552 名参与者中，平均年龄为 11（±4）岁，平均 eGFR 为 53（±20）ml/min/1.73m2，41%的患者被归类为非杓型。在非肾小球性 CKD 患者中，女性和更高的钠摄入量与收缩压和舒张压（≤0.05）下降幅度较小显著相关。在肾小球性 CKD 患者中，黑人和更大的蛋白尿与收缩压和舒张压（≤0.05）下降幅度较小显著相关。收缩压和舒张压的下降与左心室质量指数无显著相关性；然而，在样条回归图中，舒张压与左心室质量指数呈非线性关系。与舒张压下降<20%相比，舒张压下降<20%与左心室质量指数增加 1.41g/m-h（95%置信区间，-0.47 至 3.29）相关，而舒张压下降>25%与左心室质量指数增加 1.98g/m-h（95%置信区间，-0.77 至 4.73）相关，尽管这些相关性没有达到统计学意义。
结论
黑人、女性以及更大的蛋白尿和钠摄入量与 CKD 患儿的血压下降减弱显著相关。我们没有发现杓型与左心室质量指数之间存在统计学显著关联。
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