Mitsnefes MM, Xu Y, Ng DK, et al. - Ambulatory blood pressure, in comparison to clinic blood pressure alone, might afford a tool that allows better identification of children with chronic kidney disease at risk for subclinical cardiac dysfunction.

• Diastolic dysfunction is an early cardiac abnormality in chronic kidney disease.

• From the CKiD (Chronic Kidney Disease in Children) cohort, data were analyzed from 786 children and adolescents (1658 person-visits).

• Primary outcome was defined as early mitral inflow velocity-to-early mitral annular peak velocity (E/e′) ratio as a marker of left ventricular compliance.

• Younger age, a lower estimated glomerular filtration rate and hemoglobin, and a higher prevalence of hypertension and left ventricular hypertrophy were present in those with an abnormal E/e′ ratio vs those with a normal E/e′.

• Adjusted analysis showed an independent link of a higher E/e′ ratio with ambulatory (sustained) hypertension (1.66).

• Higher left ventricular mass index Z score, elevated body mass index Z score, lower hemoglobin, higher phosphorus level, and younger age were revealed as other significant independent predictors.

• There was no significant association of casual blood pressure with higher E/e′.