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24-Hour ambulatory blood pressure monitoring 7 years after intensive care unit admission

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Abstract

Background

Children who develop acute kidney injury (AKI) in the pediatric intensive care unit (PICU) may be at higher risk of long-term chronic kidney disease and hypertension. The objectives of this study were to determine the prevalence of post-discharge hypertension and albuminuria using reference-standard measurements in children admitted to the PICU, and evaluate their association with AKI.

Methods

Single-center longitudinal cohort study of children admitted to the PICU from 2005 to 2010 with 7–8 years of follow-up (n = 207). Patients were excluded if they had pre-existing chronic kidney disease, were deceased, lived > 3.5-h drive away, were unwilling/unable to provide consent/assent, or had a clotting disorder. AKI was defined by the Kidney Disease: Improving Global Outcomes creatinine definition. Office blood pressure was evaluated using age, sex, and height-based percentiles. Hypertension was defined using 24-h ambulatory blood pressure monitoring (ABPM). Albuminuria was defined as first morning urine albumin:creatinine ratio ≥ 30 mg/g. Prevalence of blood pressure outcomes was calculated. The association between AKI and outcomes was evaluated using multivariable regression.

Results

Sixty of 207 (29%) children developed AKI during PICU admission. Overall, 6% had albuminuria and 21% had elevated office blood pressure or worse. One-hundred-and-seventy-seven (86%) patients had successful ABPM data. Of these, 10 (6%) had white coat, 18 (10%) had masked, and 5 (3%) had ambulatory hypertension. There was no statistically significant difference in outcomes across AKI stages.

Conclusions

Blood pressure abnormalities are common in children 7 years after PICU admission. Future studies with longer follow-up are needed to further evaluate the association between AKI and hypertension.

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Data availability

The data underlying this article may be shared on reasonable request to the corresponding author.

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Acknowledgements

We acknowledge our research nurse Julie Ann Doucet who assisted in participant study visits. We acknowledge Vedran Cockovski for helping with manuscript preparation and submission.

Funding

M.Z. and C.M. received an operating grant from the Canadian Institutes of Health Research to perform this study. M.Z. was supported by a salary award from the Fonds de Recherche du Quebec-Sante and by institutional funds from the McGill University Health Centre.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Erin Hessey, Kelly McMahon, Ana Palijan & Michael Pizzi

  2. Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada

    Erin Hessey

  3. McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada

    Alex Paun

  4. Department of Family Medicine, McGill University, Montreal, QC, Canada

    Kelly Benisty

  5. Department of Pediatrics, Division of Nephrology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada

    Catherine Morgan

  6. Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 6th floor, Room 06.9708, Toronto, ON, M5G 0A4, Canada

    Michael Zappitelli

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  1. Erin Hessey
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  2. Alex Paun
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  3. Kelly Benisty
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  7. Catherine Morgan
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  8. Michael Zappitelli
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Contributions

Dr. Hessey conceptualized and designed the study, designed the data collection instrument, collected and analyzed data, drafted the initial manuscript, and reviewed and revised the manuscript. Mr. Paun assisted in data collection and reviewed and revised the manuscript. Dr. Benisty and Dr. McMahon assisted in the design of the data collection instruments, collected data, and reviewed and revised the manuscript. Dr. Palijan and Mr. Pizzi assisted in the design of the data collection instruments, design of data analysis tools, and reviewed and revised the manuscript. Dr. Morgan and Dr. Zappitelli conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Michael Zappitelli.

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Hessey, E., Paun, A., Benisty, K. et al. 24-Hour ambulatory blood pressure monitoring 7 years after intensive care unit admission. Pediatr Nephrol 37, 1877–1887 (2022). https://doi.org/10.1007/s00467-021-05392-2

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  • DOI: https://doi.org/10.1007/s00467-021-05392-2

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