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Ambulatory blood pressure monitoring is recommended in the clinical management of children with a solitary functioning kidney

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Abstract

Background

Children with a solitary functioning kidney are at increased risk of developing chronic kidney disease. Hypertension may be an early indicator of renal dysfunction in these patients. We determined blood pressure (BP) profiles of children with a solitary functioning kidney by using ambulatory BP monitoring (ABPM).

Methods

To assess the occurrence with (pre)hypertension, we compared ABPM to office BP measurement in 47 children with a solitary functioning kidney. None of the subjects used antihypertensive agents or had been hypertensive during previous clinical visits.

Results

Mean age of study subjects was 12.7 (±3.3) years. Hypertension was identified in ten (21 %) subjects with ABPM, whereas only two (4 %) children were hypertensive during office BP measurement (p < 0.01). Fifteen (32 %) children had an ABPM standard deviation (SD) value ≥90th percentile versus six (13 %) subjects based on office BP measurement (p = 0.051). Although 24-h ABPM SD scores were higher in the congenital type than in the acquired type of solitary functioning kidney (p ≤ 0.01), the proportions of subjects with 24-h ABPM hypertension were similar between groups (congenital 25 % versus acquired 16 %; p = NS).

Conclusions

Based on ABPM, one in five children with a solitary functioning kidney has hypertension. As the majority of these subjects were not hypertensive during office BP measurements, ABPM should be considered in the clinical management of solitary functioning kidney patients.

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Acknowledgments

We thank all patients and their parents for participating in the KIMONO study, and Monique Koot for her excellent administrative assistance.

Support

RW is funded by a grant from Fonds Nuts Ohra Zorgsubsidies, Amsterdam, The Netherlands (project number 1101-058).

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands

    Rik Westland, David F. van der Lof, Annemieke Vermeulen, Inge M. J. Dekker-van der Meer, Arend Bökenkamp & Joanna A. E. van Wijk

  2. Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands

    Michiel F. Schreuder

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  1. Rik Westland
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Correspondence to Rik Westland.

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Fig2

Supplemental figure 1 Bland–Altman plots for (a), systolic blood pressure and (b), diastolic blood pressure. Circles represent systolic BP SD scores, whereas diastolic BP SD scores are displayed by triangles. Mean bias (difference between 24–h ABPM and office BP SD scores) is depicted by the solid line and the 95 % limits of agreement (i.e., mean bias ± 1.96 × SD) are shown by the gray area. ABPM ambulatory blood pressure monitoring; BP blood pressure (GIF 16 kb)

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High-resolution image (TIFF 15903 kb)

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Westland, R., Schreuder, M.F., van der Lof, D.F. et al. Ambulatory blood pressure monitoring is recommended in the clinical management of children with a solitary functioning kidney. Pediatr Nephrol 29, 2205–2211 (2014). https://doi.org/10.1007/s00467-014-2853-0

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  • DOI: https://doi.org/10.1007/s00467-014-2853-0

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