Association of pulse pressure, pulse pressure index, and ambulatory arterial stiffness index with kidney function in a cross-sectional pediatric chronic kidney disease cohort from the CKiD study

Rupesh Raina; Shyam Polaconda; Nikhil Nair; Ronith Chakraborty; Sidharth Sethi; Vinod Krishnappa; Gaurav Kapur; Maroun Mhanna; Kirsten Kusumi

doi:10.1111/jch.13905

Association of pulse pressure, pulse pressure index, and ambulatory arterial stiffness index with kidney function in a cross-sectional pediatric chronic kidney disease cohort from the CKiD study

J Clin Hypertens (Greenwich). 2020 Jun;22(6):1059-1069. doi: 10.1111/jch.13905. Epub 2020 May 30.

Authors

Rupesh Raina^{1

2}, Shyam Polaconda³, Nikhil Nair⁴, Ronith Chakraborty², Sidharth Sethi⁵, Vinod Krishnappa⁶, Gaurav Kapur⁷, Maroun Mhanna⁸, Kirsten Kusumi¹

Affiliations

¹ Department of Pediatric Nephrology, Akron Children's Hospital, Akron, Ohio, USA.
² Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA.
³ Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.
⁴ Department of Chemistry, Case Western Reserve University, Cleveland, Ohio, USA.
⁵ Department of Pediatric Nephrology, Medanta, The Medicity, Gurgaon, India.
⁶ Consortium of Eastern Ohio Master of Public Health student, Northeast Ohio Medical University, Rootstown, Ohio, USA.
⁷ Division of Pediatric Nephrology and Hypertension, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA.
⁸ Department of Pediatrics, MetroHealth, Cleveland, Ohio, USA.

Abstract

The morbidity and mortality of adult and pediatric chronic kidney disease (CKD) and end-stage renal disease (ESRD) populations are mainly driven by cardiovascular disease (CVD). Improving CVD outcomes focuses on risk assessment of factors including diastolic blood pressure (DBP), systolic blood pressure (SBP), left ventricular mass index (LVMI), pulse pressure (PP), and pulse pressure index (PPi), which is calculated as PP/SBP. These markers are also proven predictors of CKD progression; however, their role in children has not been established. This study aims to evaluate the relationship between PP, PPi, ambulatory arterial stiffness index (AASI), and proteinuria with kidney function in pediatric CKD patients; it is a retrospective analysis of 620 patients (1-16 years) from the NIDDK Chronic Kidney Disease in Children (CKiD) registry. The authors analyzed data for three separate cohorts: an overall CKD as well as immunological versus non-immunological cause for CKD groups. An inverse relationship was found between SBP, DBP, and PP with iGFR and LVMI in the overall CKD group. Our immunological CKD subgroup showed significantly higher serum creatinine, SBP, DBP, and PP values with significantly lower serum albumin levels compared to the non-immunological group. There were no significant differences with iohexol-based glomerular filtration rate (iGFR), LVMI, PPi, or high-sensitivity C-reactive protein (hs-CRP) between the two groups. A subgroup analysis demonstrated that SBP, DBP, and PP all correlated significantly with LVMI in the immunological CKD patients but not the non-immunological subgroup. Additionally, AASI data in the overall CKD population were significantly correlated with PP, PPi, and DBP. This study is one of the first to correlate noninvasive measurements of vascular compliance including PP, PPi, and AASI with iGFR and LVMI in a pediatric CKD cohort. Improving our understanding of surrogate markers for early CVD is integral to improving the care of pediatric CKD population as these patients have yet to develop the hard end points of ESRD, heart failure, myocardial infarction, or stroke.

Keywords: AASI; chronic kidney disease; inflammation; pulse pressure; pulse pressure index.

MeSH terms

Adult
Blood Pressure
Child
Cross-Sectional Studies
Humans
Hypertension* / pathology
Hypertension* / physiopathology
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / pathology
Renal Insufficiency, Chronic* / physiopathology
Retrospective Studies
Risk Factors
Vascular Stiffness*