Effects of reduced blood pressure dipping on the progression of chronic kidney disease in children

Effects of reduced blood pressure dipping on the progression of chronic kidney disease in children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of reduced blood pressure dipping on the progression of chronic kidney disease in children Li Huarong, Chen Chaoying, Tu Juan, Lin Tiantian, Wang Nannan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6561090/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Hypertension is a common complication of chronic kidney disease (CKD) in children. It is related to the progression of CKD. However, current guidelines for hypertension management in CKD patients mainly focus on managing patients with above-target blood pressure. The effects of reduced nocturnal blood pressure dipping on CKD progression in children are poorly understood. Methods: This single-center, retrospective cohort study analyzed the clinical data of children with stage 2–5 non-dialysis CKD undergoing ambulatory blood pressure monitoring (ABPM), Clinical characteristics and laboratory parameters of children with and without hypertension and/or reduced nocturnal blood pressure dipping were analyzed. Results: Ninety-four children were included, with a median age of 10 years (interquartile range [IQR] 6–12 years), of whom 65 were male (69.1%). The median estimated glomerular filtration rate (eGFR) was 41 ml/min/1.73 m 2 , and the median 24-hour proteinuria level was 637 mg. There were 41 (43.6%) cases of ambulatory BP at target and 53 (56.4%) cases of ambulatory hypertension. Nocturnal dipping without ambulatory hypertension was found in 10 cases (10.6%), nocturnal non-dipping without ambulatory hypertension in 31 cases (33.0%), nocturnal dipping with ambulatory hypertension in 5 cases (5.3%), and nocturnal non-dipping with ambulatory hypertension in 48 cases (51.1%). The nocturnal non-dipping with ambulatory hypertension group had the lowest hemoglobin (F=2.798, P=0.045), eGFR (F=3.228, P=0.026), and 25 (OH) D3 (F=3.428, P=0.023). During a median follow-up of 15 months (IQR 7–31 months), 27 patients (28.7%) showed a decrease in eGFR of >3 ml/min/1.73 m 2 /year. Further, 21 patients (22.3%) progressed to end-stage kidney disease requiring kidney replacement therapy. The nocturnal non-dipping with ambulatory hypertension group had the highest risk of renal progression (hazard ratio [HR]=3.634; 95% confidence interval [CI], 0.866–15.258), while the nocturnal dipping with ambulatory hypertension group (HR=1.945; 95% CI, 0.273–13.865) had similar risks to the nocturnal non-dipping without ambulatory hypertension group (HR=1.584; 95% CI, 0.350–7.171). Multivariate Cox regression analysis revealed that persistent proteinuria and reduced nocturnal blood pressure dipping were associated with renal outcomes. Conclusion: Regardless of whether ambulatory blood pressure was normal, reduced blood pressure dipping was correlated with the risk of renal progression in children with CKD. Chronic Kidney Disease Children Ambulatory blood pressure monitoring blood pressure dipping progression Figures Figure 1 Background Hypertension is a common complication of chronic kidney disease (CKD) in children, with an incidence ranging from 50–80%, depending on the disease stage [ 1 ], which is far higher than the 4% prevalence of hypertension in all children [ 2 ]. It has been well-established that hypertension can damage the kidney through the activation of the endothelial system, as well as the renin-angiotensin-aldosterone system. Hypertension has also been classified as an independent risk factor for CKD [ 3 – 4 ] and can predict adult hypertension, which is related to cardiovascular events, such as left ventricular hypertrophy and atherosclerosis [ 5 ]. As such, controlling hypertension can help to delay the progression of CKD, and minimize increases in the incidence and mortality rates of related cardiovascular events. However, studies measuring office blood pressure (BP) have shown that hypertension is grossly underestimated and undertreated [ 6 – 7 ], with more than 50% of children with CKD showing abnormal blood pressure during 24-hour ambulatory blood pressure monitoring (ABPM) [ 8 ]. Further, 50% of children with CKD have nocturnal hypertension, which is difficult to identify using office blood pressure measurements [ 7 ]. The European Society of Hypertension and the American Heart Association both recommended performing routine ABPM for children with CKD as early as 2016 and 2014, respectively, to assess parameters that could not be measured in office blood pressure. These include the blood pressure load, nocturnal blood pressure, diurnal blood pressure curve, and blood pressure variability. As such, ABPM is considered to be the gold standard for diagnosing "true" hypertension status, and the only tool for assessing abnormal diurnal blood pressure patterns. Nevertheless, studies using ABPM to assess the prognosis of patients with CKD have predominantly focused on independent situations of nocturnal non-dipping and ambulatory hypertension. Current guidelines for hypertension management, including for CKD patients, have predominantly focused on controlling office hypertension and ambulatory hypertension, and management of patients with non-dipping in nocturnal blood pressure is difficult. The effect of nocturnal non-dipping on renal prognosis, particularly in children with CKD, has rarely been investigated. In this study, children with stage 2–5 CKD admitted to our hospital between January 2018 and December 2023 were systematically evaluated, stratified, and compared, according to the characteristics of ambulatory blood pressure. The influencing factors of different ambulatory blood pressure parameters on the progression of CKD were further evaluated. Methods Subjects This retrospective single-center observational study enrolled 94 children with stage 2–5 non-dialysis CKD undergoing ABPM who were admitted to the Department of Nephrology, Capital Center For Children's Health, Capital Medical University, Beijing, China between January 2018 and December 2023. This study was approved by the Ethics Committee of Capital Center For Children's Health, Capital Medical University, [SHERLL2023008]. The parents of all patients provided informed consent prior to inclusion in the study, which was conducted in strict accordance with the principles of the Declaration of Helsinki. Inclusion and exclusion criteria The inclusion criteria were as follows: 1) age 3–17 years; 2) children with stage 2–5 non-dialysis CKD, diagnosis of CKD according to the KDIGO guidelines [ 9 ]; and 3) eGFR < 90 mL/min/1.73 m 2 . The exclusion criteria were as follows: 1) underwent kidney replacement therapy (KRT) at the start of the study, and 2) incomplete clinical data. Observation and evaluation indicators The following baseline data were collected: General information, including age, sex, height, weight, body mass index (BMI), CKD stage, CKD etiology; and laboratory data, including serum creatinine (Scr), serum urea nitrogen (Urea), eGFR according to the Schwartz formula, urinary protein/creatinine (UPCR), 24-hour proteinuria, hemoglobin (HB), blood glucose, albumin (ALB), triglyceride (TG), cholesterol (Chol), low density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), calcium (Ca), phosphorus (P), total parathyroid hormone (PTH), 25 (OH) D3 level, and echocardiography. Blood pressure measurement The patients’ blood pressure was measured according to the following requirements: the width of the cuff should be at least 40% of the circumference of the child’s middle upper arm, while the length should be at least 80% of the circumference of the patient’s middle upper arm. Office blood pressure and ABPM were measured in a consulting room on the same day. Office blood pressure was measured as follows: After the children rested for 5 min, the measurement was repeated at intervals of 1–2 min, and the average value of the two measurements was recorded as the office blood pressure. ABPM was performed during hospitalization as follows: The 24-h period was divided into waking and sleeping periods; the waking period was measured every 30 min from 7:00 to 21:00, and the sleeping period was measured every 60 min from 21:00 to 7:00. Strenuous activities were avoided during the measurements, and daily activities, waking and sleeping times were recorded. The ABPM data should have at least 70% valid data [ 13 ]. Blood pressure characteristics collected by ABPM included the 24-h systolic pressure load, 24-h diastolic pressure load, 24-h mean systolic pressure, 24-h mean diastolic pressure, daytime mean systolic pressure, daytime mean diastolic pressure, nighttime mean systolic pressure, nighttime mean diastolic pressure, and nighttime blood pressure dipping rate. Patient grouping According to the nocturnal dipping status and ambulatory blood pressure, the patients were divided into four groups: nocturnal dipping without ambulatory hypertension, nocturnal non-dipping without ambulatory hypertension, nocturnal dipping with ambulatory hypertension, and nocturnal non-dipping with ambulatory hypertension. Follow-up visit Patients were followed up for at least 6 months, until they started KRT or until death. The following outcome measures were assessed: follow-up time, CKD stage, eGFR (mL/min/1.73m 2 ), UPCR, annual eGFR decline slope (mL/min/1.73m 2 /year) calculated based on eGFR change and observation time). The endpoint events were as follows: renal combined outcomes included progression to end-stage kidney disease (ESKD) requiring KRT, or rapid decline of eGFR (≥ 3 mL/min/1.73 m 2 / year). Definitions The following definitions were used for separate parameters: Office hypertension: blood pressure ≥ 95th percentile of the same sex, age and height (age < 13 years) or 130/80 mmHg (age ≥ 13 years) [ 10 ] ABPM hypertension: For children aged 3–12 years, 24-h mean systolic or diastolic blood pressure ≥ 95th percentile for gender and height; For children aged ≥ 13 years, 24-h, daytime, or nighttime mean blood pressure ≥ 125/75 mmHg, 130/80 mmHg, or 110/65 mmHg, respectively. [ 10 ] Ambulatory hypertension: meeting both office hypertension and ABPM hypertension criteria [ 10 ] Decreased nocturnal blood pressure: dipping in mean nocturnal systolic or diastolic blood pressure < 10% on ABPM [ 11 ] Left ventricular hypertrophy (LVH): Echocardiography-measured left ventricular end-diastolic diameter (LVDd), ventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPWT). According to the Devereux formula, the left ventricular mass (left ventricular, LVM = 1.04X0.8X[(LVDd + IVST + LVPWT) 3 -LVDd 3 ] + 0.6) was calculated, followed by the left ventricular mass index (LVMI) = LVM/ height 2.7 ; relative wall thickness (RWT) = (IVST + LVPWT) /LVDd. The diagnostic criteria for LVH were as follows: (1) LVMI > 37.08 g/m 2.7 in male and 34.02 g/m 2.7 in female; ② RWT > 0.36. Meeting either ① or ② is LVH[ 12 ]. Statistical methods SPSS 26.0 statistical software was used for data processing. The Kolmogorov–Smirnov test was applied to evaluate the normality of data distribution. Normally distributed variables are expressed as mean ± standard deviation (x ± s), and differences between groups were evaluated by one-way analysis of variance (ANOVA). Non-normally distributed measurement data are expressed as the median (IQR), and the Mann–Whitney U test was used for comparisons between groups. Count data are presented as the use cases (%). The χ 2 test or Fisher’s exact probability method were used for inter-group comparison. Statistical significance was set at P < 0.05. A multivariate Cox proportional hazards model was tested and applied to estimate the risk of renal outcomes (hazard ratio [HR] and 95% confidence interval [CI]) in the four groups based on nocturnal dipping status and ambulatory hypertension (nocturnal dipping and non-ambulatory hypertension were used as reference groups). Results General characteristics of the study participants A total of 94 children were enrolled, with a median age of 10 years (IQR 6–12 years), including 65 males (69.1%). The most common causes of CKD were congenital anomalies of the kidney and urinary tract (CAKUT) in 52 patients (55.3%), glomerular disease in 21 patients (22.3%), tubular disease in 10 patients (10.6%), thrombotic microangiopathy (TMA) in 4 patients (4.3%), cystic nephropathy in 3 patients (3.2%), and other in 4 patients (4.3%). Overall, 29 (30.8%), 31 (33.0%), 9 (9.6%), and 25 (26.6%) patients had stage 2, 3, 4, and 5 of CKD, respectively. Baseline laboratory measurements were as follows: median eGFR 41 ml/min/1.73 m 2 (IQR 16–65) and a median 24-hour proteinuria of 637 mg (IQR 168–1714 mg). The baseline blood pressure characteristics were as follows: there were 47 patients (50%) with office hypertension, with incidence rates ranging from 44.8% of patients in CKD the stage 2 of CKD to 72.0% of patients in the stage 5 of CKD. Further, there were 56 patients with ABPM hypertension (60.0%), 53 with ambulatory hypertension (56.4%),and 79 (84.0%) with reduced nocturnal blood pressure dipping. In the entire cohort, the baseline median office systolic blood pressure was 115 mmHg, median office diastolic blood pressure was 70 mmHg, median 24-h systolic load was 43%, median 24-h diastolic load was 18%, median 24-h systolic blood pressure was 119 mmHg, and median 24-h diastolic blood pressure was 68 mmHg. Overall, the median nocturnal systolic and diastolic blood pressures decreased by 9.6% and 5.2%, respectively. Patients were stratified according to ambulatory blood pressure and nocturnal dipping status, as follows: 10 patients (10.6%) had nocturnal dipping without ambulatory hypertension, 31 patients (33.0%) had nocturnal non-dipping without ambulatory hypertension, 5 patients (5.3%) had nocturnal dipping with ambulatory hypertension, and 48 patients (51.1%) had nocturnal non-dipping with ambulatory hypertension. Comparison of ambulatory blood pressure and other baseline clinical features in children with CKD revealed no differences in the distribution of the etiology and stage of CKD among the four groups. The lowest HB (F = 2.798, P = 0.045), eGFR (F = 3.228, P = 0.026), and 25 (OH) D3 (F = 3.428, P = 0.023) levels were found in the nocturnal non-dipping with ambulatory hypertension group, all of which showed statistical differences. There were no significant differences in ALB, SUA, Chol, TG, LDL, Ca, P, and PTH across the four groups. Comparison of ambulatory blood pressure with LVH revealed no statistically significant difference in the distribution of LVH among the four groups. The LVMI in the nocturnal non-dipping with ambulatory hypertension group was significantly higher than that in the other three groups, but there was no statistical difference. RWT in the four groups was not statistically different, as shown in Table 1.2. Regarding antihypertensive drugs, 42 patients (44.7%) received calcium channel blockers (CCB), and 19 (20.2%) received angiotensin converting enzyme inhibitors (ACEIs)/angiotensinⅡreceptor blockers (ARBs). The use of antihypertensive drugs in the four groups was not significantly different Renal outcomes At a median follow-up of 15 months (IQR 7–31 months), 27 patients (28.7%) had an eGFR decline > 3 ml/min.1.73m 2 /year, 21 (22.3%) progressed to ESKD requiring KRT, and 2 died. The children who died had nocturnal non-dipping with ambulatory hypertension accompanied by LVH, and refractory hypertension, treated with three and four different antihypertensive drugs, respectively. The incidences of renal endpoint events in the four groups are presented in Figs. 1 . The highest risk of this outcome was observed in the nocturnal non-dipping with ambulatory hypertension group (HR = 3.634 [95% CI, 0.866–15.258]), while the nocturnal dipping with ambulatory hypertension group (HR = 1.945 [95% CI, 0.273–13.865]) had similar risks to the nocturnal non-dipping without ambulatory hypertension group (HR = 1.584 [95% CI, 0.350–7.171]) (Table 3 ). Univariate regression analysis, significant difference was found between nocturnal non-dipping status, HB, Scr, eGFR, persistent proteinuria, and renal outcomes. However, multivariate Cox regression analysis revealed that only persistent proteinuria and nocturnal non-dipping were associated with renal outcomes. Table 1 Comparison of clinical characteristics of children with ambulatory BP and nocturnal dipping status Non-ambulatory hypertension ambulatory hypertension Dipping (n = 10) Non-dipping (n = 31) Dipping (n = 5) Non-dipping (n = 48) F/X2/Z P Male n(%) 6 (60.0%) (87.1%) 3 (60.0%) 29 (60.4%). 6.985 0.072 Age, y 9.3 ± 4.0 9.6 ± 3.4 9.8 ± 5.1 9.3 ± 3.9 0.076 0.973 BMI, kg/m2 17.8 ± 5.0 18.4 ± 4.2 21.7 ± 3.8 17.5 ± 4.0 1.613 0.192 HB, g/dL 120.9 ± 10.4 117.2 ± 22.3 105.0 ± 23.3 104.1 ± 25.6 2.798 0.045 Scr, umol/L 158.4 ± 123.9 137.2 ± 107.5 285.2 ± 274.2 279.7 ± 296.7 2.698 0.050 Urea, mmol/L 9.5 ± 5.2 12.1 ± 7.0 11.2 ± 7.0 17.2 ± 15.2 1.929 0.131 eGFR, mL/min/1.73m 2 58.9 ± 21.7 41.0 ± 16.4 40.7 ± 34.2 33.4 ± 27.5 3.228 0.026 Urinary protein volume, mg/kg.d 9.5 (2.0, 33.6) 11.0 (3.2, 54.0) 56.0 (11.9, 98.5) 24.8 (8.24, 74.4) 0.192 ALB, g/L 41.1 ± 3.8 41.6 ± 4.8 39.6 ± 7.9 38.4 ± 7.8 1.621 0.190 SUA, umol/L 384.2 ± 103.6 444.7 ± 126.4 458.0 ± 163.7 456.0 ± 140.2 0.813 0.490 Chol mg/dL 4.6 ± 1.2 4.9 ± 2.2 4.8 ± 0.2 11.6 ± 46.2 0.325 0.807 TG,mmol/L 1.3 ± 0.5 8.9 ± 39.3 2.4 ± 1.3 1.7 ± 0.8 0.699 0.555 LDL,mmol/L 2.9 ± 1.4 3.0 ± 1.5 2.8 ± 0.5 3.0 ± 1.3 0.030 0.993 glucose,mmol/L 4.7 ± 0.2 4.6 ± 0.4 4.5 ± 0.2 4.6 ± 0.6 0.180 0.910 Ca mg/dL 2.3 ± 0.1 2.2 ± 0.2 2.2 ± 0.2 2.2 ± 0.3 0.287 0.835 P mg/dL 2.0 ± 0.5 1.7 ± 0.4 1.5 ± 0.6 1.8 ± 0.4 1.824 0.149 PTH,pmol/L 39.0 (16.4, 49.5) 38.0 (25.9, 98.0) 70.5 (23.8, 168.7) 71.0 (44.0, 178.0) 0.081 25(OH)D3,ng/ml 51.5 ± 21.9 55.6 ± 35.6 47.9 ± 7.9 44.0 ± 26.9 3.428 0.023 CKD stage n(%) 2 3 (30.0%) 8 (25.8%) 2 (40.0%). 16 (33.3%). 13.206 0.154 3 4 (40.0%) 16 (51.6%). 1 (20.0%). 10 (20.8%) 4 1 (10.0%). 4 (12.9%) 0 (0.0%) 4 (8.3%) 5 2 (20.0%). 3 (9.7%) 2 (40.0%). 18 (37.5%). Causes of CKD n(%) CAKUT 6 (60.0%) 19 (61.3%). 2 (40.0%). 25 (52.1%) 15.549 0.413 Glomerular 2 (20.0%). 4 (12.9%) 2 (40.0%). 13 (27.1%). Tubular 0 (0.0%) 5 (16.1%) 0 (0.0%) 5 (10.4%) TMA 0 (0.0%) 1 (3.2%). 0 (0.0%) 3 (6.2%) Cystic 1 (10.0%). 0 (0.0%) 1 (20.0%). 1 (2.1%). Other 1 (10.0%). 2 (6.5%). 0 (0.0%) 1 (2.1%). eGFR:estimated glomerular filtration rate;BMI:body mass index; Scr:serum creatinine; Urea:serum urea nitrogen; UPCR:urinary protein/creatinine; HB:hemoglobin; ALB:albumin; TG:triglyceride; Chol:cholesterol; LDL-C:low density lipoprotein cholesterol ;SUA:serum uric acid; Ca:calcium; P:phosphorus; PTH:parathyroid hormone; CAKUT:congenital anomalies of the kidney and urinary tract; TMA:thrombotic microangiopathy; Table 2 Comparison of blood pressure and LVH in children with ambulatory BP and nocturnal dipping status Non-ambulatory hypertension ambulatory hypertension Dipping (n = 10) Non-dipping (n = 31) Dipping (n = 5) Non-dipping (n = 48) F/X2/Z P office mm Hg Systolic blood pressure 107.8 ± 10.9 108.8 ± 12.7 137.6 ± 43.6 122.5 ± 23.7 4.871 0.003 Diastolic Blood pressure 66.6 ± 10.1 67.1 ± 10.6 83.2 ± 27.2 77.3 ± 17.3 3.732 0.014 Load % Systolic Blood pressure 14.8 ± 16.2 22.1 ± 19.4 56.2 ± 18.5 67.5 ± 27.4 27.352 0.000 Diastolic Blood pressure 5.67 ± 7.48 8.2 ± 12.6 15.7 ± 15.0 49.7 ± 30.8 21.635 0.000 24 hours mmHg median systolic blood pressure 107.1 ± 9.59 108.0 ± 9.17 126.0 ± 15.8 128.8 ± 15.9 18.382 0.000 median diastolic blood pressure 60.9 ± 6.5 61.4 ± 7.1 69.4 ± 10.4 78.2 ± 15.3 14.301 0.000 Daytime mmHg median systolic blood pressure 110.9 ± 9.1 109.0 ± 9.5 124.6 ± 14.0 129.3 ± 15.8 15.625 0.000 median diastolic blood pressure 64.7 ± 6.6 62.3 ± 7.3 68.4 ± 4.2 78.5 ± 15.2 12.081 0.000 Nighttime mmHg median systolic blood pressure 96.2 ± 7.8 104.5 ± 9.5 106.8 ± 12.3 127.0 ± 17.8 21.674 0.000 median diastolic blood pressure 51.1 ± 5.5 57.7 ± 7.9 59.0 ± 8.8 77.1 ± 17.4 17.768 0.000 Dipping rate % Systolic blood pressure 13.2 ± 2.8 5.5 ± 2.7 12.2 ± 1.7 4.5 ± 2.9 34.141 0.000 Diastolic Blood pressure 20.9 ± 5.35 12.4 ± 15.0 18.1 ± 5.1 9.3 ± 16.9 1.931 0.130 LVH 4/9 (44.4%). 15/31 (48.4%). By 2/4 (50.0%) 21/37 (56.8%) 0.709 0.871 LVMI, g/m 2.7 33.2 ± 15.9 37.1 ± 17.7 49.2 ± 21.2 58.3 ± 71.4 1.186 0.332 RWT 0.31 ± 0.05 0.30 ± 0.04 0.34 ± 0.08 0.30 ± 0.04 0.784 0.506 LVH:Left ventricular hypertrophy; LVMI:left ventricular mass index; RWT:relative wall thickness Table 3 Comparison of clinical indicators and renal outcomes in CKD children by Cox regression analysis Clinical Features Univariate analysis Multivariate Analysis OR (95% CI) P OR (95% CI) P eGFR 0.986 (0.974–0.999) 0.036 0.999 (0.974–1.025) 0.961 Scr 1.001 (1.000-1.002) 0.013 1.002 (0.997–1.006) 0.422 HB 0.987 (0,976-0.998) 0.028 0.986 (0.958–1.015) 0.339 persistent proteinuria 1.009 (1.002–1.016) 0.016 1.202 (1.007–1.024) 0.043 Blood pressure Four groups 1.527 (1.131–2.061) 0.006 1.631 (1.012–2.521) 0.044 Discussion The results of this retrospective study indicate that nocturnal non-dipping with ambulatory hypertension is the most common pattern of hypertension in children with CKD and is associated with the highest risk of renal outcomes. Interestingly, even when ambulatory hypertension is not present, nocturnal non-dipping status alone is an important predictor of renal disease progression. Hypertension is a common complication of CKD in children, as well as an independent risk factor for the progression of CKD [ 13 – 15 ]. Controlling blood pressure can effectively delay CKD [ 16 ]. Studies have shown that ambulatory hypertension and nocturnal non-dipping status are associated with a high risk of renal events. This coexisting state of hypertension is the most common in clinical practice, accounting for 51.1% of the cases in this study, which is consistent with previous data collected from adult patients with CKD [ 17 ]. However, the predictive values of ambulatory and nocturnal hypertension alone have been limited in childhood CKD studies. Therefore, in this study, we combined the characteristics of ambulatory blood pressure and nocturnal dipping status in children with CKD to assess their independent prognostic effects on renal outcomes. Among hypertension with nocturnal non-dipping in adult CKD patients, the detection rate was 70% in an Italian study, and 83–86% in multiple Japanese studies [ 17 – 18 ]. However, pediatric data are lacking in previous studies. In one study of the CKiD cohort, 41% of children with CKD cohort did not have an available nocturnal dipping status [ 19 ], while 84.0% of children with CKD had a nocturnal non-dipping status in our study. Even in the group without ambulatory hypertension, there were 32.9% of patients with nocturnal non-dipping. The pathogenesis of nocturnal hypertension is thought to be primarily related to sympathetic overdrive, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system [ 20 – 21 ]. Circadian rhythm disturbances of sodium urine, particularly in patients with CKD in whom salt-sensitive hypertension is more common, occurs in the kidneys at night, with a stress natriuretic effect, resulting in non-spoonful blood pressure [ 22 ]. The glomerular vascular resistance and pressure load increase, thereby aggravating kidney injury and resulting in decreased kidney function, which is one of the primary mechanisms underlying nocturnal hypertension in Asians. In a cohort study conducted by Borrelli et al. [ 17 ], the stratified group with nocturnal non-dipping with ambulatory hypertension had the highest risk of cardiovascular events and renal outcomes. However, even in those with normal ambulatory blood pressure, the risk of cardiovascular endpoints (HR = 2.06 [95%CI, 1.15–3.68]) and renal outcomes (HR = 1.82 [95%CI, 1.17–2.82]) was increased in those with nocturnal non-dipping. These results indicate that nocturnal non-dipping is associated with CKD progression and more frequent cardiovascular events, indicating it as an independent risk factor of adverse events in patients with CKD. In prospective observational studies, Wang et al. [ 23 ] previously found that non-dipping in blood pressure at night was associated with worse renal outcomes, but not with the 24-h mean systolic blood pressure. In the present study, more than half of the children with ambulatory hypertension above the target level and without dipping had the highest risk of renal progression. Similarly, we observed that even if ambulatory blood pressure was normal, the risk of renal outcomes in the non-dipping group was higher than that in the dipping group. Deja A [ 24 ] confirmed that nocturnal hypertension can serve as a predictive indicator of a rapid decrease in eGFR (> 3ml/min. 1.73m 2 /year). However, contradictory conclusions have also been drawn. For example, two studies in Japan [ 25 – 26 ] both showed that in the group with ambulatory hypertension, non-dipping in nighttime blood pressure was not associated with the risk of renal events. This discrepancy may be due to the study design, definition of the goal of ambulatory blood pressure, and differences in population and ethnicity [ 27 ]. Despite the differences in these findings, owing to the high incidence of nocturnal hypertension in patients with CKD, and the extent to which the blood pressure autoregulation mechanism and circadian rhythm disappear as CKD progresses [ 28 ], the importance of assessing circadian blood pressure rhythms in children with CKD is clear, even in children with early CKD. Nocturnal hypertension is as important as daytime hypertension, which together have an additive effect on the progression of renal function [ 29 ]. This study had some limitations. Firstly, the sample size was limited and there was a lack of long-term follow-up data. Further, it should be noted that hypertension in children with CKD may result from multiple factors, including diet, drugs, and other concomitant diseases. No stratified analysis was conducted on children with white coat hypertension and masked hypertension. Moreover, this was a retrospective study to assess the blood pressure status of patients with CKD at a single time point, which may have reduced the accuracy of risk stratification. In the future, multicenter and large-sample prospective studies on children with CKD should be conducted to fully evaluate the prognostic value of ABPM in pediatric patients with CKD through high-quality evidence, including studies with long-term follow-up, guided by ABPM and comprehensive and in-depth assessment of its impact on target organ damage. In conclusion, this retrospective, single-center study analyzed the prognostic value of ABPM for renal progression in children with CKD. In our cohort, nocturnal non-dipping blood pressure was common in children with CKD, which could not be detected by office blood pressure measurements, thereby underscoring the superiority of ABPM as a diagnostic tool for hypertension in children with CKD. In addition to proteinuria, CKD progression is dependent on blood pressure, and independent of ambulatory hypertension, while nocturnal non-dipping blood pressure is also a risk predictor of renal progression. Therefore, nighttime and diurnal blood pressure characteristics should be closely monitored when assessing blood pressure in children with CKD. Abbreviations CKD chronic kidney disease ABPM ambulatory blood pressure monitoring eGFR estimated glomerular filtration rate BP blood pressure BMI body mass index Scr serum creatinine Urea serum urea nitrogen UPCR urinary protein/creatinine HB hemoglobin ALB albumin TG triglyceride Chol cholesterol LDL-C low density lipoprotein cholesterol SUA serum uric acid Ca calcium P phosphorus PTH parathyroid hormone ESKD end-stage kidney disease LVH Left ventricular hypertrophy LVDd left ventricular end-diastolic diamete IVST ventricular septal thickness LVPWT left ventricular posterior wall thickness LVM left ventricular mass LVMI left ventricular mass index RWT relative wall thickness CAKUT congenital anomalies of the kidney and urinary tract TMA thrombotic microangiopathy CCB calcium channel blockers ACEI angiotensin converting enzyme inhibitors ARB angiotensinⅡreceptor blockers Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of the Capital Center For Children's Health, Capital Medical University [SHERLL2023008]. The parents of all patients provided informed consent prior to inclusion in the study Consent for publication: Not applicable Funding: This study was funded by the Beijing Municipal Hospital Research and Cultivation Program Project of China (No. PC2023050). Author Contribution Material preparation and data collection were performed by Li Huarong. Data analysis and revision were performed by Li Huarong, Chen Chaoying, and Tu Juan. The first draft of the manuscript was written by Li Huarong. All authors contributed to the study conception, design, and revision. All authors read and approved the final manuscript Acknowledgement This is a short text to acknowledge the contributions of specific colleagues, institutions, or agencies that aided the efforts of the authors. Availability of data and materials: The datasets generated during this study are available on request to the corresponding author. Clinical trial number: not applicable Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. References Ku E, Lee BJ, Wei J, et al. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis. 2019;74(1):120–31. The doi: 10.1053 / j.a JKD 2018.12.044. Mancia G, Kreutz R, Brunstrom M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874–2071. The doi: 10.1097 / HJH. 0000000000003480. Atkinson MA, Ng DK, Warady BA, et al. The CKiD study: overview and summary of findings related to kidney disease progression. Pediatr Nephrol. 2021;36(3):527–38. 10.1007/s00467-019-04458-6 . Reynolds BC, Roem JL, Ng DKS, et al. Association of Time-Varying Blood Pressure With Chronic Kidney Disease Progression in Children. JAMA Netw Open. 2020;3(2):e1921213–1921213. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. 10.1542/peds.2017-1904 . Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC /ACPM/AGS/APhA/ASH/ASPC /NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; 71 (6): e13 - e115. Doi: 10.1161 / HYP. 0000000000000065. Hill-Horowitz T, Merchant K, Abdullah M et al. Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines. J Pediatr. 2024; 266:113895. Doi: 10.1016 / j.j peds. 2023.113895. Hsu CN, Lu PC, Lo MH, et al. The Association between Nitric Oxide Pathway, Blood Pressure Abnormalities, and Cardiovascular Risk Profile in Pediatric Chronic Kidney Disease. Int J Mol Sci. 2019;20(21):5301. 10.3390/ijms20215301 . Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30. 10.7326/0003-4819-158-11-201306040-00007 . Flynn JT, Urbina EM, Brady TM et al. Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension. 2022; (7): 79 e114 - e124. Doi: 10.1161 / HYP. 0000000000000215. Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63(5):1116–35. 10.1161 / HYP. 0000000000000007. Hietalampi H, Pahkala K, Jokinen E et al. Left ventricular mass and geometry in adolescence: early childhood determinants. Hypertension. 2012; (5): 1266–72. Doi: 10.1161 / HYPERTENSIONAHA. 112.194290. Fu X, Ren H, Xie J et al. Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis. JAMA Netw Open. 2022; Five (5): e2214460. Doi: 10.1001 / jamanetworkopen. 2022.14460. Gluck CA, Forrest CB, Davies AG, et al. Evaluating Kidney Function Decline in Children with Chronic Kidney Disease Using a Multi-Institutional Electronic Health Record Database. Clin J Am Soc Nephrol. 2023;18(2):173–82. The doi: 10.2215 / CJN. 0000000000000051. Taha K, Catapang M, Becknell B, et al. Hypertension in children with congenital anomalies of the kidney and urinary tract. Pediatr Nephrol. 2024;39(4):1185–92. 10.1007/s00467-023-06207-2 . Sinha MD, Gu H, Douiri A, et al. Intensive compared with less intensive blood pressure control to prevent adverse cardiac remodelling in children with chronic kidney disease (HOT-KID): a parallel-group, open-label, multicentre, randomised, controlled trial. Lancet Child Adolesc Health. 2023;7(1):26–36. 10.1016/S2352-4642(22)00302-9 . Borrelli S, Garofalo C, Gabbai FB et al. Dipping Status, Ambulatory Blood Pressure Control, Cardiovascular Disease, and Kidney Disease Progression: A Multicenter Cohort Study of CKD. Am J Kidney Dis. 2023;. 81 (1) : 15 to 24 e1, doi: 10.1053 / j.a JKD 2022.04.010. Rahman M, Wang X, Bundy JD, et al. Prognostic Significance of Ambulatory BP Monitoring in CKD: A Report from the Chronic Renal Insufficiency Cohort (CRIC) Study. J Am Soc Nephrol. 2020;31(11):2609–21. 10.1681/ASN.2020030236 . Bakhoum CY, Katz R, Samuels JA, et al. Nocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort. Clin J Am Soc Nephrol. 2022;17(1):75–82. 10.2215/CJN.09810721 . Jeong JH, Fonkoue IT, Quyyumi AA, et al. Nocturnal blood pressure is associated with sympathetic nerve activity in patients with chronic kidney disease. Physiol Rep. 2020;8(20):e14602. 10.14814/phy2.14602 . Ohashi N, Isobe S, Ishigaki S, et al. Increased heart rate is associated with intrarenal renin-angiotensin system activation in chronic kidney disease patients. Clin Exp Nephrol. 2019;23(9):1109–18. 10.1007/s10157-019-01746-1 . Fukuda M, Kimura G. Salt sensitivity and nondippers in chronic kidney disease. Curr Hypertens Rep. 2012;14(5):382–7. 10.1007/s11906-012-0286-3 . Wang C, Ye Z, Li Y, et al. Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study. Sci Rep. 2016;6:34932. 10.1038/srep34932 . Deja A, Skrzypczyk P, Leszczyska B, et al. Reduced Blood Pressure Dipping Is A Risk Factor for the Progression of Chronic Kidney Disease in Children. Biomedicines. 2022;10(9):2171. 10.3390. da Kusaba T, Kado T. Ambulatory blood pressure monitoring-based analysis of long-term outcomes for kidney disease progression. Sci Rep. 2019;9(1):19296. 10.1038/s41598-019-55732-4 . Kado H, Kusaba T, Matoba S, et al. Normotensive non-dipping blood pressure profile does not predict the risk of chronic kidney disease progression. Hypertens Res. 2019;42(3):354–61. 10.1038/s41440-018-0155-9 . Pagi R, Yadin O, Wesseling-Perry K, et al. Racial-ethnic diversity in ambulatory blood pressure monitoring in children with chronic kidney disease. Pediatr Nephrol. 2023;38(3):819–27. 10.1007/s00467-022-05659-2 . Mojon A, Ayala DE, Pineiro L et al. Comparison of ambulatory blood pressure parameters of hypertensive patients with and without chronic kidney disease. Chronobiol Int. 2013; 30 (1–2): 145 – 58. 10.3109/07420528.2012.703083 Larkins NG. Expanding Insights Into the Role of Nocturnal Blood Pressure Variation in Children. Kidney Int Rep. 2022;7(11):2327–8. The doi: 10.1016 / j. kir. 2022.09.021. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 26 May, 2025 Reviews received at journal 25 May, 2025 Reviews received at journal 19 May, 2025 Reviews received at journal 14 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviewers agreed at journal 12 May, 2025 Reviewers agreed at journal 11 May, 2025 Reviewers invited by journal 08 May, 2025 Editor invited by journal 08 May, 2025 Editor assigned by journal 08 May, 2025 Submission checks completed at journal 08 May, 2025 First submitted to journal 30 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6561090","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455546851,"identity":"6990ff71-83b9-46eb-abbe-8a60d2670744","order_by":0,"name":"Li Huarong","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Huarong","suffix":""},{"id":455546854,"identity":"d8831514-0870-46d3-b687-4af5e06df54b","order_by":1,"name":"Chen Chaoying","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDACCSBmbAASzCBOBZscG3vzARK0WJzhM+bjOZZApBYQqGyTS5wnkaOAVwf/7OZjD37usJMzOM57+MWNM2bpbQw5DAw/KrbhtuTOsXTD3jPJxgaH+dIsZ1Sk5bYxnD3A2HPmNk4tBhI5ZtKMbcyJGw7zmBlLnDmW28bYl8DM2IZPS/43oJZ6iJa/bf/T2Zh5DAhoyWEDajkM0mL8QLKNLYGNjYAWiRtpZpK9bceNJYG2MEicYTNs42FLOIjPL/wzkp9J/GyrluM7f8b4AzAq5eXnPz744EcFbi1woHCAgU0CxjlAWD0QyDcwMH8gSuUoGAWjYBSMOAAAtKNWmhgptY0AAAAASUVORK5CYII=","orcid":"","institution":"Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Chen","middleName":"","lastName":"Chaoying","suffix":""},{"id":455546856,"identity":"1628d82d-7792-4932-a479-1388661bb03d","order_by":2,"name":"Tu Juan","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tu","middleName":"","lastName":"Juan","suffix":""},{"id":455546858,"identity":"01ab78c1-d552-4281-8513-5b2acd54f839","order_by":3,"name":"Lin Tiantian","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Tiantian","suffix":""},{"id":455546860,"identity":"fde6d279-e8dc-4c0b-8f48-9c89f74e222d","order_by":4,"name":"Wang Nannan","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Nannan","suffix":""}],"badges":[],"createdAt":"2025-04-30 04:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6561090/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6561090/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82774391,"identity":"3eef1293-763d-4554-848e-c25100bbd18a","added_by":"auto","created_at":"2025-05-15 07:06:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28499,"visible":true,"origin":"","legend":"\u003cp\u003eRisk analysis of renal endpoints across different groups of children with CKD stratified by blood pressure.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6561090/v1/9161eb5e4c86f7879730d766.png"},{"id":82776149,"identity":"da2bf06c-3f86-4aa1-8dc4-61d41766dc26","added_by":"auto","created_at":"2025-05-15 07:22:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":872624,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6561090/v1/5b249eed-c0fb-4874-b1fe-408a795ab0eb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of reduced blood pressure dipping on the progression of chronic kidney disease in children","fulltext":[{"header":"Background","content":"\u003cp\u003eHypertension is a common complication of chronic kidney disease (CKD) in children, with an incidence ranging from 50\u0026ndash;80%, depending on the disease stage [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], which is far higher than the 4% prevalence of hypertension in all children [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It has been well-established that hypertension can damage the kidney through the activation of the endothelial system, as well as the renin-angiotensin-aldosterone system. Hypertension has also been classified as an independent risk factor for CKD [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and can predict adult hypertension, which is related to cardiovascular events, such as left ventricular hypertrophy and atherosclerosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As such, controlling hypertension can help to delay the progression of CKD, and minimize increases in the incidence and mortality rates of related cardiovascular events.\u003c/p\u003e \u003cp\u003eHowever, studies measuring office blood pressure (BP) have shown that hypertension is grossly underestimated and undertreated [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], with more than 50% of children with CKD showing abnormal blood pressure during 24-hour ambulatory blood pressure monitoring (ABPM) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Further, 50% of children with CKD have nocturnal hypertension, which is difficult to identify using office blood pressure measurements [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The European Society of Hypertension and the American Heart Association both recommended performing routine ABPM for children with CKD as early as 2016 and 2014, respectively, to assess parameters that could not be measured in office blood pressure. These include the blood pressure load, nocturnal blood pressure, diurnal blood pressure curve, and blood pressure variability. As such, ABPM is considered to be the gold standard for diagnosing \"true\" hypertension status, and the only tool for assessing abnormal diurnal blood pressure patterns.\u003c/p\u003e \u003cp\u003eNevertheless, studies using ABPM to assess the prognosis of patients with CKD have predominantly focused on independent situations of nocturnal non-dipping and ambulatory hypertension. Current guidelines for hypertension management, including for CKD patients, have predominantly focused on controlling office hypertension and ambulatory hypertension, and management of patients with non-dipping in nocturnal blood pressure is difficult. The effect of nocturnal non-dipping on renal prognosis, particularly in children with CKD, has rarely been investigated. In this study, children with stage 2\u0026ndash;5 CKD admitted to our hospital between January 2018 and December 2023 were systematically evaluated, stratified, and compared, according to the characteristics of ambulatory blood pressure. The influencing factors of different ambulatory blood pressure parameters on the progression of CKD were further evaluated.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThis retrospective single-center observational study enrolled 94 children with stage 2\u0026ndash;5 non-dialysis CKD undergoing ABPM who were admitted to the Department of Nephrology, Capital Center For Children's Health, Capital Medical University, Beijing, China between January 2018 and December 2023. This study was approved by the Ethics Committee of Capital Center For Children's Health, Capital Medical University, [SHERLL2023008]. The parents of all patients provided informed consent prior to inclusion in the study, which was conducted in strict accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were as follows: 1) age 3\u0026ndash;17 years; 2) children with stage 2\u0026ndash;5 non-dialysis CKD, diagnosis of CKD according to the KDIGO guidelines [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; and 3) eGFR\u0026thinsp;\u0026lt;\u0026thinsp;90 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: 1) underwent kidney replacement therapy (KRT) at the start of the study, and 2) incomplete clinical data.\u003c/p\u003e\n\u003ch3\u003eObservation and evaluation indicators\u003c/h3\u003e\n\u003cp\u003eThe following baseline data were collected: General information, including age, sex, height, weight, body mass index (BMI), CKD stage, CKD etiology; and laboratory data, including serum creatinine (Scr), serum urea nitrogen (Urea), eGFR according to the Schwartz formula, urinary protein/creatinine (UPCR), 24-hour proteinuria, hemoglobin (HB), blood glucose, albumin (ALB), triglyceride (TG), cholesterol (Chol), low density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), calcium (Ca), phosphorus (P), total parathyroid hormone (PTH), 25 (OH) D3 level, and echocardiography.\u003c/p\u003e\n\u003ch3\u003eBlood pressure measurement\u003c/h3\u003e\n\u003cp\u003eThe patients\u0026rsquo; blood pressure was measured according to the following requirements: the width of the cuff should be at least 40% of the circumference of the child\u0026rsquo;s middle upper arm, while the length should be at least 80% of the circumference of the patient\u0026rsquo;s middle upper arm. Office blood pressure and ABPM were measured in a consulting room on the same day.\u003c/p\u003e \u003cp\u003eOffice blood pressure was measured as follows: After the children rested for 5 min, the measurement was repeated at intervals of 1\u0026ndash;2 min, and the average value of the two measurements was recorded as the office blood pressure.\u003c/p\u003e \u003cp\u003eABPM was performed during hospitalization as follows: The 24-h period was divided into waking and sleeping periods; the waking period was measured every 30 min from 7:00 to 21:00, and the sleeping period was measured every 60 min from 21:00 to 7:00. Strenuous activities were avoided during the measurements, and daily activities, waking and sleeping times were recorded. The ABPM data should have at least 70% valid data [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Blood pressure characteristics collected by ABPM included the 24-h systolic pressure load, 24-h diastolic pressure load, 24-h mean systolic pressure, 24-h mean diastolic pressure, daytime mean systolic pressure, daytime mean diastolic pressure, nighttime mean systolic pressure, nighttime mean diastolic pressure, and nighttime blood pressure dipping rate.\u003c/p\u003e\n\u003ch3\u003ePatient grouping\u003c/h3\u003e\n\u003cp\u003eAccording to the nocturnal dipping status and ambulatory blood pressure, the patients were divided into four groups: nocturnal dipping without ambulatory hypertension, nocturnal non-dipping without ambulatory hypertension, nocturnal dipping with ambulatory hypertension, and nocturnal non-dipping with ambulatory hypertension.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up visit\u003c/h2\u003e \u003cp\u003ePatients were followed up for at least 6 months, until they started KRT or until death.\u003c/p\u003e \u003cp\u003eThe following outcome measures were assessed: follow-up time, CKD stage, eGFR (mL/min/1.73m\u003csup\u003e2\u003c/sup\u003e), UPCR, annual eGFR decline slope (mL/min/1.73m\u003csup\u003e2\u003c/sup\u003e/year) calculated based on eGFR change and observation time).\u003c/p\u003e \u003cp\u003eThe endpoint events were as follows: renal combined outcomes included progression to end-stage kidney disease (ESKD) requiring KRT, or rapid decline of eGFR (\u0026ge;\u0026thinsp;3 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e/ year).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eThe following definitions were used for separate parameters:\u003c/p\u003e \u003cp\u003eOffice hypertension: blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;95th percentile of the same sex, age and height (age\u0026thinsp;\u0026lt;\u0026thinsp;13 years) or 130/80 mmHg (age\u0026thinsp;\u0026ge;\u0026thinsp;13 years) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eABPM hypertension: For children aged 3\u0026ndash;12 years, 24-h mean systolic or diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;95th percentile for gender and height; For children aged\u0026thinsp;\u0026ge;\u0026thinsp;13 years, 24-h, daytime, or nighttime mean blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;125/75 mmHg, 130/80 mmHg, or 110/65 mmHg, respectively. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAmbulatory hypertension: meeting both office hypertension and ABPM hypertension criteria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDecreased nocturnal blood pressure: dipping in mean nocturnal systolic or diastolic blood pressure\u0026thinsp;\u0026lt;\u0026thinsp;10% on ABPM [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eLeft ventricular hypertrophy (LVH): Echocardiography-measured left ventricular end-diastolic diameter (LVDd), ventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPWT). According to the Devereux formula, the left ventricular mass (left ventricular, LVM\u0026thinsp;=\u0026thinsp;1.04X0.8X[(LVDd\u0026thinsp;+\u0026thinsp;IVST\u0026thinsp;+\u0026thinsp;LVPWT)\u003csup\u003e3\u003c/sup\u003e-LVDd\u003csup\u003e3\u003c/sup\u003e]\u0026thinsp;+\u0026thinsp;0.6) was calculated, followed by the left ventricular mass index (LVMI)\u0026thinsp;=\u0026thinsp;LVM/ height\u003csup\u003e2.7\u003c/sup\u003e; relative wall thickness (RWT) = (IVST\u0026thinsp;+\u0026thinsp;LVPWT) /LVDd. The diagnostic criteria for LVH were as follows: (1) LVMI\u0026thinsp;\u0026gt;\u0026thinsp;37.08 g/m\u003csup\u003e2.7\u003c/sup\u003e in male and 34.02 g/m\u003csup\u003e2.7\u003c/sup\u003e in female; ② RWT\u0026thinsp;\u0026gt;\u0026thinsp;0.36. Meeting either ① or ② is LVH[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eSPSS 26.0 statistical software was used for data processing. The Kolmogorov\u0026ndash;Smirnov test was applied to evaluate the normality of data distribution. Normally distributed variables are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and differences between groups were evaluated by one-way analysis of variance (ANOVA). Non-normally distributed measurement data are expressed as the median (IQR), and the Mann\u0026ndash;Whitney U test was used for comparisons between groups. Count data are presented as the use cases (%). The χ\u003csup\u003e2\u003c/sup\u003e test or Fisher\u0026rsquo;s exact probability method were used for inter-group comparison. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. A multivariate Cox proportional hazards model was tested and applied to estimate the risk of renal outcomes (hazard ratio [HR] and 95% confidence interval [CI]) in the four groups based on nocturnal dipping status and ambulatory hypertension (nocturnal dipping and non-ambulatory hypertension were used as reference groups).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eGeneral characteristics of the study participants\u003c/h2\u003e\n \u003cp\u003eA total of 94 children were enrolled, with a median age of 10 years (IQR 6\u0026ndash;12 years), including 65 males (69.1%). The most common causes of CKD were congenital anomalies of the kidney and urinary tract (CAKUT) in 52 patients (55.3%), glomerular disease in 21 patients (22.3%), tubular disease in 10 patients (10.6%), thrombotic microangiopathy (TMA) in 4 patients (4.3%), cystic nephropathy in 3 patients (3.2%), and other in 4 patients (4.3%). Overall, 29 (30.8%), 31 (33.0%), 9 (9.6%), and 25 (26.6%) patients had stage 2, 3, 4, and 5 of CKD, respectively.\u003c/p\u003e\n \u003cp\u003eBaseline laboratory measurements were as follows: median eGFR 41 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e (IQR 16\u0026ndash;65) and a median 24-hour proteinuria of 637 mg (IQR 168\u0026ndash;1714 mg).\u003c/p\u003e\n \u003cp\u003eThe baseline blood pressure characteristics were as follows: there were 47 patients (50%) with office hypertension, with incidence rates ranging from 44.8% of patients in CKD the stage 2 of CKD to 72.0% of patients in the stage 5 of CKD. Further, there were 56 patients with ABPM hypertension (60.0%), 53 with ambulatory hypertension (56.4%),and 79 (84.0%) with reduced nocturnal blood pressure dipping.\u003c/p\u003e\n \u003cp\u003eIn the entire cohort, the baseline median office systolic blood pressure was 115 mmHg, median office diastolic blood pressure was 70 mmHg, median 24-h systolic load was 43%, median 24-h diastolic load was 18%, median 24-h systolic blood pressure was 119 mmHg, and median 24-h diastolic blood pressure was 68 mmHg. Overall, the median nocturnal systolic and diastolic blood pressures decreased by 9.6% and 5.2%, respectively.\u003c/p\u003e\n \u003cp\u003ePatients were stratified according to ambulatory blood pressure and nocturnal dipping status, as follows: 10 patients (10.6%) had nocturnal dipping without ambulatory hypertension, 31 patients (33.0%) had nocturnal non-dipping without ambulatory hypertension, 5 patients (5.3%) had nocturnal dipping with ambulatory hypertension, and 48 patients (51.1%) had nocturnal non-dipping with ambulatory hypertension.\u003c/p\u003e\n \u003cp\u003eComparison of ambulatory blood pressure and other baseline clinical features in children with CKD revealed no differences in the distribution of the etiology and stage of CKD among the four groups. The lowest HB (F\u0026thinsp;=\u0026thinsp;2.798, P\u0026thinsp;=\u0026thinsp;0.045), eGFR (F\u0026thinsp;=\u0026thinsp;3.228, P\u0026thinsp;=\u0026thinsp;0.026), and 25 (OH) D3 (F\u0026thinsp;=\u0026thinsp;3.428, P\u0026thinsp;=\u0026thinsp;0.023) levels were found in the nocturnal non-dipping with ambulatory hypertension group, all of which showed statistical differences. There were no significant differences in ALB, SUA, Chol, TG, LDL, Ca, P, and PTH across the four groups. Comparison of ambulatory blood pressure with LVH revealed no statistically significant difference in the distribution of LVH among the four groups. The LVMI in the nocturnal non-dipping with ambulatory hypertension group was significantly higher than that in the other three groups, but there was no statistical difference. RWT in the four groups was not statistically different, as shown in Table\u0026nbsp;1.2.\u003c/p\u003e\n \u003cp\u003eRegarding antihypertensive drugs, 42 patients (44.7%) received calcium channel blockers (CCB), and 19 (20.2%) received angiotensin converting enzyme inhibitors (ACEIs)/angiotensinⅡreceptor blockers (ARBs). The use of antihypertensive drugs in the four groups was not significantly different\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eRenal outcomes\u003c/h2\u003e\n \u003cp\u003eAt a median follow-up of 15 months (IQR 7\u0026ndash;31 months), 27 patients (28.7%) had an eGFR decline\u0026thinsp;\u0026gt;\u0026thinsp;3 ml/min.1.73m\u003csup\u003e2\u003c/sup\u003e/year, 21 (22.3%) progressed to ESKD requiring KRT, and 2 died. The children who died had nocturnal non-dipping with ambulatory hypertension accompanied by LVH, and refractory hypertension, treated with three and four different antihypertensive drugs, respectively. The incidences of renal endpoint events in the four groups are presented in Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The highest risk of this outcome was observed in the nocturnal non-dipping with ambulatory hypertension group (HR\u0026thinsp;=\u0026thinsp;3.634 [95% CI, 0.866\u0026ndash;15.258]), while the nocturnal dipping with ambulatory hypertension group (HR\u0026thinsp;=\u0026thinsp;1.945 [95% CI, 0.273\u0026ndash;13.865]) had similar risks to the nocturnal non-dipping without ambulatory hypertension group (HR\u0026thinsp;=\u0026thinsp;1.584 [95% CI, 0.350\u0026ndash;7.171]) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Univariate regression analysis, significant difference was found between nocturnal non-dipping status, HB, Scr, eGFR, persistent proteinuria, and renal outcomes. However, multivariate Cox regression analysis revealed that only persistent proteinuria and nocturnal non-dipping were associated with renal outcomes.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of clinical characteristics of children with ambulatory BP and nocturnal dipping status\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNon-ambulatory hypertension\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eambulatory hypertension\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDipping (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-dipping (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDipping\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-dipping (n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF/X2/Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(87.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (60.4%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.973\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHB, g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104.1\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScr, umol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158.4\u0026thinsp;\u0026plusmn;\u0026thinsp;123.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137.2\u0026thinsp;\u0026plusmn;\u0026thinsp;107.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e285.2\u0026thinsp;\u0026plusmn;\u0026thinsp;274.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e279.7\u0026thinsp;\u0026plusmn;\u0026thinsp;296.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrea, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeGFR, mL/min/1.73m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.9\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.7\u0026thinsp;\u0026plusmn;\u0026thinsp;34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.4\u0026thinsp;\u0026plusmn;\u0026thinsp;27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrinary protein volume, mg/kg.d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003cp\u003e(2.0, 33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003cp\u003e(3.2, 54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.0\u003c/p\u003e\n \u003cp\u003e(11.9, 98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003cp\u003e(8.24, 74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALB, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSUA, umol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e384.2\u0026thinsp;\u0026plusmn;\u0026thinsp;103.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e444.7\u0026thinsp;\u0026plusmn;\u0026thinsp;126.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e458.0\u0026thinsp;\u0026plusmn;\u0026thinsp;163.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e456.0\u0026thinsp;\u0026plusmn;\u0026thinsp;140.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChol mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTG,mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL,mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eglucose,mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCa mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePTH,pmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003cp\u003e(16.4, 49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003cp\u003e(25.9, 98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003cp\u003e(23.8, 168.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003cp\u003e(44.0, 178.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(OH)D3,ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.5\u0026thinsp;\u0026plusmn;\u0026thinsp;21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.6\u0026thinsp;\u0026plusmn;\u0026thinsp;35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCKD stage n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (40.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (33.3%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (51.6%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (20.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (40.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (37.5%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCauses of CKD n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCAKUT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (61.3%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (40.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (52.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGlomerular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (40.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (27.1%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTubular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.2%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCystic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (20.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.1%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10.0%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (6.5%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.1%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eeGFR:estimated glomerular filtration rate;BMI:body mass index; Scr:serum creatinine; Urea:serum urea nitrogen; UPCR:urinary protein/creatinine; HB:hemoglobin; ALB:albumin; TG:triglyceride; Chol:cholesterol; LDL-C:low density lipoprotein cholesterol ;SUA:serum uric acid; Ca:calcium; P:phosphorus; PTH:parathyroid hormone; CAKUT:congenital anomalies of the kidney and urinary tract; TMA:thrombotic microangiopathy;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of blood pressure and LVH in children with ambulatory BP and nocturnal dipping status\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNon-ambulatory hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eambulatory hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDipping (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-dipping (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDipping\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-dipping\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF/X2/Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoffice mm Hg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137.6\u0026thinsp;\u0026plusmn;\u0026thinsp;43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e122.5\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic Blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.2\u0026thinsp;\u0026plusmn;\u0026thinsp;27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLoad %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic Blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.2\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.5\u0026thinsp;\u0026plusmn;\u0026thinsp;27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic Blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 hours mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emedian systolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emedian diastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaytime mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emedian systolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emedian diastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNighttime mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emedian systolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emedian diastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.1\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDipping rate %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic Blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/9 (44.4%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15/31 (48.4%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBy 2/4 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/37 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVMI, g/m\u003csup\u003e2.7\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.3\u0026thinsp;\u0026plusmn;\u0026thinsp;71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRWT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eLVH:Left ventricular hypertrophy; LVMI:left ventricular mass index; RWT:relative wall thickness\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of clinical indicators and renal outcomes in CKD children by Cox regression analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eClinical Features\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMultivariate Analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeGFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.986 (0.974\u0026ndash;0.999)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.999 (0.974\u0026ndash;1.025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.001 (1.000-1.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.002 (0.997\u0026ndash;1.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.987 (0,976-0.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.986 (0.958\u0026ndash;1.015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epersistent proteinuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.009 (1.002\u0026ndash;1.016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.202 (1.007\u0026ndash;1.024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood pressure Four groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.527 (1.131\u0026ndash;2.061)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.631 (1.012\u0026ndash;2.521)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this retrospective study indicate that nocturnal non-dipping with ambulatory hypertension is the most common pattern of hypertension in children with CKD and is associated with the highest risk of renal outcomes. Interestingly, even when ambulatory hypertension is not present, nocturnal non-dipping status alone is an important predictor of renal disease progression.\u003c/p\u003e \u003cp\u003eHypertension is a common complication of CKD in children, as well as an independent risk factor for the progression of CKD [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Controlling blood pressure can effectively delay CKD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies have shown that ambulatory hypertension and nocturnal non-dipping status are associated with a high risk of renal events. This coexisting state of hypertension is the most common in clinical practice, accounting for 51.1% of the cases in this study, which is consistent with previous data collected from adult patients with CKD [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, the predictive values of ambulatory and nocturnal hypertension alone have been limited in childhood CKD studies. Therefore, in this study, we combined the characteristics of ambulatory blood pressure and nocturnal dipping status in children with CKD to assess their independent prognostic effects on renal outcomes.\u003c/p\u003e \u003cp\u003eAmong hypertension with nocturnal non-dipping in adult CKD patients, the detection rate was 70% in an Italian study, and 83\u0026ndash;86% in multiple Japanese studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, pediatric data are lacking in previous studies. In one study of the CKiD cohort, 41% of children with CKD cohort did not have an available nocturnal dipping status [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], while 84.0% of children with CKD had a nocturnal non-dipping status in our study. Even in the group without ambulatory hypertension, there were 32.9% of patients with nocturnal non-dipping. The pathogenesis of nocturnal hypertension is thought to be primarily related to sympathetic overdrive, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Circadian rhythm disturbances of sodium urine, particularly in patients with CKD in whom salt-sensitive hypertension is more common, occurs in the kidneys at night, with a stress natriuretic effect, resulting in non-spoonful blood pressure [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The glomerular vascular resistance and pressure load increase, thereby aggravating kidney injury and resulting in decreased kidney function, which is one of the primary mechanisms underlying nocturnal hypertension in Asians.\u003c/p\u003e \u003cp\u003eIn a cohort study conducted by Borrelli et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the stratified group with nocturnal non-dipping with ambulatory hypertension had the highest risk of cardiovascular events and renal outcomes. However, even in those with normal ambulatory blood pressure, the risk of cardiovascular endpoints (HR\u0026thinsp;=\u0026thinsp;2.06 [95%CI, 1.15\u0026ndash;3.68]) and renal outcomes (HR\u0026thinsp;=\u0026thinsp;1.82 [95%CI, 1.17\u0026ndash;2.82]) was increased in those with nocturnal non-dipping. These results indicate that nocturnal non-dipping is associated with CKD progression and more frequent cardiovascular events, indicating it as an independent risk factor of adverse events in patients with CKD. In prospective observational studies, Wang et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] previously found that non-dipping in blood pressure at night was associated with worse renal outcomes, but not with the 24-h mean systolic blood pressure. In the present study, more than half of the children with ambulatory hypertension above the target level and without dipping had the highest risk of renal progression. Similarly, we observed that even if ambulatory blood pressure was normal, the risk of renal outcomes in the non-dipping group was higher than that in the dipping group. Deja A [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] confirmed that nocturnal hypertension can serve as a predictive indicator of a rapid decrease in eGFR (\u0026gt;\u0026thinsp;3ml/min. 1.73m\u003csup\u003e2\u003c/sup\u003e/year). However, contradictory conclusions have also been drawn. For example, two studies in Japan [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] both showed that in the group with ambulatory hypertension, non-dipping in nighttime blood pressure was not associated with the risk of renal events. This discrepancy may be due to the study design, definition of the goal of ambulatory blood pressure, and differences in population and ethnicity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Despite the differences in these findings, owing to the high incidence of nocturnal hypertension in patients with CKD, and the extent to which the blood pressure autoregulation mechanism and circadian rhythm disappear as CKD progresses [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], the importance of assessing circadian blood pressure rhythms in children with CKD is clear, even in children with early CKD. Nocturnal hypertension is as important as daytime hypertension, which together have an additive effect on the progression of renal function [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study had some limitations. Firstly, the sample size was limited and there was a lack of long-term follow-up data. Further, it should be noted that hypertension in children with CKD may result from multiple factors, including diet, drugs, and other concomitant diseases. No stratified analysis was conducted on children with white coat hypertension and masked hypertension. Moreover, this was a retrospective study to assess the blood pressure status of patients with CKD at a single time point, which may have reduced the accuracy of risk stratification. In the future, multicenter and large-sample prospective studies on children with CKD should be conducted to fully evaluate the prognostic value of ABPM in pediatric patients with CKD through high-quality evidence, including studies with long-term follow-up, guided by ABPM and comprehensive and in-depth assessment of its impact on target organ damage.\u003c/p\u003e \u003cp\u003eIn conclusion, this retrospective, single-center study analyzed the prognostic value of ABPM for renal progression in children with CKD. In our cohort, nocturnal non-dipping blood pressure was common in children with CKD, which could not be detected by office blood pressure measurements, thereby underscoring the superiority of ABPM as a diagnostic tool for hypertension in children with CKD. In addition to proteinuria, CKD progression is dependent on blood pressure, and independent of ambulatory hypertension, while nocturnal non-dipping blood pressure is also a risk predictor of renal progression. Therefore, nighttime and diurnal blood pressure characteristics should be closely monitored when assessing blood pressure in children with CKD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echronic kidney disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eABPM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eambulatory blood pressure monitoring\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eeGFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eestimated glomerular filtration rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eblood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eScr\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eserum creatinine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUrea\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eserum urea nitrogen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUPCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eurinary protein/creatinine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ealbumin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etriglyceride\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eChol\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echolesterol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDL-C\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elow density lipoprotein cholesterol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSUA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eserum uric acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCa\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecalcium\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ephosphorus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eparathyroid hormone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eend-stage kidney disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft ventricular hypertrophy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVDd\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular end-diastolic diamete\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eventricular septal thickness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVPWT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular posterior wall thickness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular mass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRWT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erelative wall thickness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAKUT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econgenital anomalies of the kidney and urinary tract\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethrombotic microangiopathy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecalcium channel blockers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACEI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eangiotensin converting enzyme inhibitors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eangiotensinⅡreceptor blockers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e This study was approved by the Ethics Committee of the Capital Center For Children's Health, Capital Medical University [SHERLL2023008]. The parents of all patients provided informed consent prior to inclusion in the study\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was funded by the Beijing Municipal Hospital Research and Cultivation Program Project of China (No. PC2023050).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMaterial preparation and data collection were performed by Li Huarong. Data analysis and revision were performed by Li Huarong, Chen Chaoying, and Tu Juan. The first draft of the manuscript was written by Li Huarong. All authors contributed to the study conception, design, and revision. All authors read and approved the final manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis is a short text to acknowledge the contributions of specific colleagues, institutions, or agencies that aided the efforts of the authors.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThe datasets generated during this study are available on request to the corresponding author.\u003c/p\u003e \u003cp\u003eClinical trial number: not applicable\u003c/p\u003e \u003cp\u003eCompeting interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKu E, Lee BJ, Wei J, et al. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis. 2019;74(1):120\u0026ndash;31. 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The doi: 10.1016 / j. kir. 2022.09.021.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic Kidney Disease, Children, Ambulatory blood pressure monitoring, blood pressure dipping, progression","lastPublishedDoi":"10.21203/rs.3.rs-6561090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6561090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHypertension is a common complication of chronic kidney disease (CKD) in children. It is related to the progression of CKD. However, current guidelines for hypertension management in CKD patients mainly focus on managing patients with above-target blood pressure. The effects of reduced nocturnal blood pressure dipping on CKD progression in children are poorly understood.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This single-center, retrospective cohort study analyzed the clinical data of children with stage 2–5 non-dialysis CKD undergoing ambulatory blood pressure monitoring (ABPM), Clinical characteristics and laboratory parameters of children with and without hypertension and/or reduced nocturnal blood pressure dipping were analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Ninety-four children were included, with a median age of 10 years (interquartile range [IQR] 6–12 years), of whom 65 were male (69.1%). The median estimated glomerular filtration rate (eGFR) was 41 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e, and the median 24-hour proteinuria level was 637 mg. There were 41 (43.6%) cases of ambulatory BP at target and 53 (56.4%) cases of ambulatory hypertension. Nocturnal dipping without ambulatory hypertension was found in 10 cases (10.6%), nocturnal non-dipping without ambulatory hypertension in 31 cases (33.0%), nocturnal dipping with ambulatory hypertension in 5 cases (5.3%), and nocturnal non-dipping with ambulatory hypertension in 48 cases (51.1%). The nocturnal non-dipping with ambulatory hypertension group had the lowest hemoglobin (F=2.798, P=0.045), eGFR (F=3.228, P=0.026), and 25 (OH) D3 (F=3.428, P=0.023). During a median follow-up of 15 months (IQR 7–31 months), 27 patients (28.7%) showed a decrease in eGFR of \u0026gt;3 ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e/year. Further, 21 patients (22.3%) progressed to end-stage kidney disease requiring kidney replacement therapy. The nocturnal non-dipping with ambulatory hypertension group had the highest risk of renal progression (hazard ratio [HR]=3.634; 95% confidence interval [CI], 0.866–15.258), while the nocturnal dipping with ambulatory hypertension group (HR=1.945; 95% CI, 0.273–13.865) had similar risks to the nocturnal non-dipping without ambulatory hypertension group (HR=1.584; 95% CI, 0.350–7.171). Multivariate Cox regression analysis revealed that persistent proteinuria and reduced nocturnal blood pressure dipping were associated with renal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Regardless of whether ambulatory blood pressure was normal, reduced blood pressure dipping was correlated with the risk of renal progression in children with CKD.\u003c/p\u003e","manuscriptTitle":"Effects of reduced blood pressure dipping on the progression of chronic kidney disease in children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-15 07:06:02","doi":"10.21203/rs.3.rs-6561090/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-26T07:09:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-26T02:50:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T21:43:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-14T10:16:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217965774030411563544350295687812181515","date":"2025-05-13T12:53:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52698603281790966000919575786724325144","date":"2025-05-12T06:17:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319250696276096497328133195291031465308","date":"2025-05-12T03:43:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-08T09:30:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T09:09:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-08T06:48:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-08T06:42:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-04-30T04:42:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5e1fd2b-038d-41e6-9d52-972f9b18b6a9","owner":[],"postedDate":"May 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T13:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-15 07:06:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6561090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6561090","identity":"rs-6561090","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}