Ambulatory blood pressure monitoring and subclinical inflammation in children with chronic kidney disease

Background. Children with chronic kidney disease (CKD) are characterized by increased risk of hypertension and chronic low-grade inflammation. The aim of the study was the analysis of relation between parameters of ambulatory blood pressure monitoring (ABPM) and subclinical inflammation in children with CKD. Material and methods. Study group included 27 paediatric patients (age 14.23 ± 3.57 years) with CKD stage 2–5; 18 children with previously recognized hypertension. In all patients we evaluated ABPM, office blood pressure, complete blood count and selected clinical and biochemical parameters. Results. In the study group, GFR was from 7.05 to 86.73, mean 40.88 ± 25.82 mL/min/1.73 m 2 . All 9 children without hypertension had normal blood pressure in ABPM, but ABPM detected poor blood pressure control in 7 among 18 (38.9%) children with previously recognized and treated hypertension. Abnormal circadian blood pressure profile was found in 12 (44.4%) children: 9/18 (50.0%) with hypertension and 3/9 (33.3%) with normal BP. Systolic, diastolic, mean blood pressure and diastolic blood pressure load correlated with neutrophil count, neutrophilto- lymphocyte ratio and platelet-to-lymphocyte ratio (r = 0.39–0.49, p = 0.010–0.044); diastolic and mean blood pressure and diastolic blood pressure load with parathormone (r = 0.48–0.57, p = 0.005–0.023); diastolic blood pressure load with phosphate and calcium-phosphorus product (r = 0.44–0.47, p = 0.021-0.030); diastolic blood pressure dipping with phosphate (r = –0.43, p = 0.034). Conclusions. 1. Ambulatory blood pressure monitoring should be used in children with chronic kidney disease on a regular basis, especially in those with arterial hypertension. 2. Blood pressure in children with chronic kidney disease may be related to degree of subclinical inflammation.