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. 2016 Nov;31(11):2137-44.
doi: 10.1007/s00467-016-3425-2. Epub 2016 Jun 5.

Association of blood pressure variability and neurocognition in children with chronic kidney disease

Marc B Lande  1 , Susan R Mendley  2 , Matthew B Matheson  3 , Shlomo Shinnar  4 , Arlene C Gerson  5 , Joshua A Samuels  6 , Bradley A Warady  7 , Susan L Furth  8 , Stephen R Hooper  9
Affiliations

Association of blood pressure variability and neurocognition in children with chronic kidney disease

Marc B Lande et al. Pediatr Nephrol. 2016 Nov.

Abstract

Background: Children with chronic kidney disease (CKD) and hypertension have increased blood pressure variability (BPV), which has been associated with lower neurocognitive test scores in adults. Children with CKD are at risk for decreased neurocognitive function. Our objective was to determine whether children with CKD and increased BPV had worse performance on neurocognitive testing compared with children with CKD and lower BPV.

Methods: This was a cross-sectional and longitudinal analysis of the relation between BPV and neurocognitive test performance in children ≥6 years enrolled in the Chronic Kidney Disease in Children (CKiD) study. Visit-to-visit BPV was assessed by the standard deviation of visit BPs (BPV-SD) and average real variability (ARV). Ambulatory BPV was assessed by SD of wake and sleep periods on 24-h ambulatory BP monitoring.

Results: We assessed 650 children with a mean follow-up period of 4.0 years. Children with systolic visit-to-visit BPV in the upper tertile had lower scores on Delis-Kaplan Executive Function System (D-KEFS) Verbal Category Switching than those with BPV in the lower tertile (BPV-SD, 8.3 vs. 9.5, p = 0.006; ARV, 8.5 vs. 9.6, p = 0.02). On multivariate analysis, the association between lower Category Switching score and increased BPV remained significant after controlling for mean BP, demographic characteristics, and disease-related variables [BPV-SD, β = -0.7, 95 % confidence interval (CI) -1.28 to -0.12; ARV, β = -0.54, CI -1.05 to -0.02). Ambulatory BPV was not independently associated with any cognitive measure.

Conclusions: Higher systolic visit-to-visit BPV was independently associated with decreased D-KEFS Category Switching scores in children with mild-to-moderate CKD.

Keywords: CKD; Hypertension; Kidney; Neuropsychological testing; Pediatric.

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Conflict of interest statement

The authors report that they have no conflict of interest.

Figures

Figure 1
Figure 1
Median values and distribution of visit-to-visit systolic and diastolic BPV for both BP-SD and ARV. All BPs were indexed to the 95th percentile for age, gender, and height for that subject. The middle tertile is shaded in grey. BPV: Blood pressure variability, BPV-SD: standard deviation of visit BPs, ARV: average real variability, DBP: diastolic blood pressure, SBP: systolic blood pressure
See this image and copyright information in PMC

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