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Indicator Details — Children and Adolescents: Prevalence of Left Ventricular Hypertrophy Among Children with CKDa
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a LVH, left ventricular hypertrophy, defined as left ventricular mass index >95th percentile in normal children and adolescents. Results stratified by hypertension (n=198): normotension, no hypertension (=systolic or diastolic blood pressure >95th percentile for age, gender, and height) detected by either casual or ambulatory measurements; masked hypertension, hypertension detected by ambulatory but not casual measurements; and confirmed hypertension, hypertension detected in both casual and ambulatory measurements. Note that white coat hypertension (hypertension in casual measurements only) was rare (n=4); thus, data are not presented. Adapted from Mistefenes et al. (2010).

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 MeasurePrevalence of left ventricular hypertrophy among children with CKD
Data SourceCKiD prospective observational cohort study
Type of Data SourcePrivate
Data SetCKiD summarized data
Health Care System DataNo
Regional or National?National
Demographic GroupChildren (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)
NumeratorEnrolled children with echocardiographic data and left ventricular mass index (LVMI) >95th percentile of normal children/adolescents
DenominatorEnrolled children with good-quality echocardiographic data
Definition of CKDSchwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)
Glomerular filtration rateMeasured, by iohexol
Primary Data Source IndicatorLVMI
Primary Indicator Method of MeasurementMeasured by M-mode and Doppler echocardiography by American Society of Echocardiography criteria, with reading and analysis at single center
Secondary (1) VariableHypertension
Secondary (1) Indicator Method of MeasurementMeasured 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 VariableAll
Period Currently Available2004–2008
Pending DataNone for baseline; further visits scheduled
Additional Data Items of InterestStage of CKD, stratification variables of interest (age, gender, race/ethnicity )
Limitations of IndicatorNot all echocardiographic results were usable and there may be variation in reading/analysis
Analytical ConsiderationsData summarized by CKiD investigators (see Mistefenes et al.); as with all cohort studies, selection bias and possible confounding
References and Sources:

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd