Arterial stiffening in children with early chronic kidney disease is associated with blood pressure but not decline in kidney function: a longitudinal study from the HOT-KID cohort

Abstract Background Children with chronic kidney disease (CKD) are at risk of hypertension and increased arterial stiffness. We examined the roles of blood pressure (BP) and kidney function in development of arterial stiffening in children with early CKD, compared to healthy children. Methods Children who attended for two measurements (mean interval 3.1 ± 1.4 years) of carotid-femoral pulse wave velocity (PWV) as part of the HOT-KID study were included. Annual progression of PWV (PWV AP ) was compared for children with CKD ( n = 106) versus healthy controls ( n = 45), adjusting for mean arterial pressure (MAP) and other risk factors at baseline and follow-up. Multivariable linear regression analyses identified variables significantly associated with PWV AP for each group. Results There was no significant difference in PWV AP between children with CKD and those without, when adjusted for key covariates at baseline and follow-up (0.12 ± 0.03 m/s/year and 0.12 ± 0.05 m/s/year respectively, P = 0.977). In healthy controls, PWV AP was independently associated with annual progression of MAP (MAP AP , β = 0.49, P = 0.006), whereas in children with CKD, PWV AP was strongly associated with both baseline MAP and MAP AP ( β = 0.26, P = 0.007 and β = 0.53, P < 0.001, respectively) but not baseline or change in estimated glomerular filtration rate. Conclusions These results indicate that there is no demonstrable difference in arterial stiffness between children with early CKD and those without. Renal function in early CKD does not appear to affect arterial stiffening, independent of the BP. The strong association between arterial stiffening and MAP suggests a need for careful BP control in children with CKD. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information.