Clinical study of ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria

Objective To investigate ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease (CKD) combined with proteinuria. Methods Ambulatory blood pressure (ABP) reports of 150 consecutive cases with stage Ⅰ-Ⅱ CKD combined with proteinuria in our hospital from January 2019 to October 2022 were analyzed retrospectively to find out the incidence of hypertension, the clinical characteristics of the rhythm of ABP among various renal diseases. Age, gender, body mass index, CKD stage, proteinuria and steroids were compared between ambulatory hypertension group and normal ambulatory blood pressure group. Results The incidence of white coat and masked hypertension was 2.67% and 12.00% respectively. The incidence of ambulatory hypertension was high (ambulatory hypertension 14% vs clinic hypertension 7.33%); 118 patients(78.67%) with stage Ⅰ-Ⅱ CKD combined with proteinuria have demonstrated abnormal ABP rhythms, but no statistically significant differences were observed among the various renal diseases (P>0.05). There was a significant difference in the incidence of clinic hypertension between the massive proteinuria and non-massive proteinuria groups (P<0.05), while no statistical significance was found in ABP rhythm (P>0.05). There were no significant differences in age, gender, body mass index, CKD stage and steroids between the ambulatory hypertension group and the normal ambulatory blood pressure group (P>0.05). However, the incidence of massive proteinuria in the ambulatory hypertension group was higher than that in the normal ambulatory blood pressure group [13/21(61.9%) vs. 30/129(23.2%)，P <0.001]. Conclusions The ABP rhythm can alter in 80.00% children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria, mainly in non-dipper and anti-dipping patterns, independent of the type of renal disease and the degree of proteinuria. Ambulatory hypertension is correlated with the degree of proteinuria, which may provide valuable guidance for the rational clinical use of antihypertensive medications.