Overall, 17% of children with CKD had left ventricular hypertrophy (LVH), a risk factor for cardiovascular disease.
Pediatric CKD patients with hypertension were significantly more likely than those without hypertension to have LVH (20% and 34% of children with masked and confirmed hypertension, respectively, had LVH, compared to 8% of children without hypertension).
LVH is prevalent in the pediatric CKD population and may be associated with blood pressure.
Chart Explanation: Overall, 17% of pediatric CKD patients had LVH. The proportion with LVH was significantly higher in those with hypertension (20% for masked hypertension; 34% for confirmed hypertension) than those without hypertension (8%; P<0.003 overall).
The Chronic Kidney Disease in Children (CKiD) study is a prospective observational study of an estimated 500 children (1-16 years old) at 48 North American centers with varying degrees of CKD severity, which was designed to measure consequences in pediatric CKD patients. As with all cohort studies, recruitment bias and lack of representativeness may influence estimates.
Analyses for this measure were restricted to the 366 children enrolled in CKiD with good-quality echocardiography and results were analyzed at a single center. Left ventricular hypertrophy, a risk factor for cardiovascular disease, was defined as left ventricular mass index >95th percentile in normal children and adolescents. Casual blood pressure was measured during an office visit and three auscultatory measurements were averaged. Ambulatory blood pressure was monitored for 24 hours and values were averaged. Complete methods can be found in Mistefenes et al. (2010).
|Description of Measure||Prevalence of left ventricular hypertrophy among children with CKD|
|Data Source||CKiD prospective observational cohort study|
|Type of Data Source||Private|
|Data Set||CKiD summarized data|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Children (1-16 years old) with mild to moderate CKD (Schwartz-estimated GFR of 30-90 ml/min/1.73 m²) who are treated throughout 48 pediatric nephrology centers in North America (46 U.S., 2 Canadian centers)|
|Numerator||Enrolled children with echocardiographic data and left ventricular mass index (LVMI) >95th percentile of normal children/adolescents|
|Denominator||Enrolled children with good-quality echocardiographic data|
|Definition of CKD||Schwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)|
|Glomerular filtration rate||Measured, by iohexol|
|Primary Data Source Indicator||LVMI|
|Primary Indicator Method of Measurement||Measured by M-mode and Doppler echocardiography by American Society of Echocardiography criteria, with reading and analysis at single center|
|Secondary (1) Variable||Hypertension|
|Secondary (1) Indicator Method of Measurement||Measured systolic and diastolic blood pressure, both casual (average of three auscultatory measurements at single visit) and ambulatory (24-hour monitoring)|
|Frequency of Measurement (Primary)||Once (baseline)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||2004–2008|
|Pending Data||None for baseline; further visits scheduled|
|Additional Data Items of Interest||Stage of CKD, stratification variables of interest (age, gender, race/ethnicity )|
|Limitations of Indicator||Not all echocardiographic results were usable and there may be variation in reading/analysis|
|Analytical Considerations||Data summarized by CKiD investigators (see Mistefenes et al.); as with all cohort studies, selection bias and possible confounding|