Abstract
Abstract P197: The Total And Direct Effects Of Cardiovascular Risk Factors On Target Organ Injury And The Indirect Effect Mediated Through Blood Pressure Severity: Modifying Effect Of Chronic Kidney Disease
Hypertension (Dallas, Tex. 1979), Vol.80(Suppl_1)
09/2023
DOI: 10.1161/hyp.80.suppl_1.P197
Abstract
Abstract only Youth-onset chronic kidney disease (CKD) is associated with early development of increased cardiovascular (CV) disease risk. CV health factors (CVHF) such as obesity, dyslipidemia, and hyperglycemia contribute to CV risk, but their specific role in target organ injury (TOI) development in youth with CKD is not well understood. Our objective was to determine the modifying effect of CKD on the total and direct effects of CVHF on TOI and the indirect effect mediated through blood pressure (BP) severity in youth with HTN disorders, hypothesizing that CKD would increase the mediating role of BP. Interim cross-sectional analysis of baseline data from the SUPERHERO Registry, a multisite retrospective registry of EHR data from youth referred for HTN disorders. Diagnoses were defined by ICD-10 codes unless otherwise specified. Inclusion criteria were age <19 years and HTN disorder from 1/1/2015-12/31/2022 at initial subspecialty clinic visit. Exclusion criteria were dialysis, kidney transplantation, or pregnancy. Presence of 0-3 CVHF defined our exposure: any combination of obesity (by BMI %ile), dyslipidemia, or hyperglycemia. Outcome was TOI (kidney and/or heart). Mediator was BP by HTN severity (defined by U.S. pediatric guidelines). Total and direct effects of CVHF on TOI and indirect effect mediated via HTN were analyzed using generalized linear models and causal mediation analysis adjusted for unmet social needs and participant home region, stratified by CKD. Of 11580 participants, 488 (4%) had a CKD diagnosis. Presence of only 1 CVHF was associated with lower odds of TOI overall in youth without CKD (OR 0.69, 95% CL 0.59, 0.81) but higher odds in youth with CKD (OR 1.7, 95% CL 0.98, 2.8), interaction term p <0.05. Presence of 2 CVHF was associated with higher odds of overall TOI (OR 1.53; 95% CL 1.14, 2.04) and heart-/kidney-specific TOI (OR 1.45 to 1.92). We found low prevalence of 3 CVHF and heart-specific TOI. We found no evidence of BP mediation or interaction for overall or organ-specific TOI. Our findings may be due to differences in kidney TOI between youth with and without CKD, reliance on ICD-10 codes, or different practices for TOI surveillance in youth with CKD. Future ongoing steps include analyzing laboratory and echocardiogram results for precision.
Details
- Title: Subtitle
- Abstract P197: The Total And Direct Effects Of Cardiovascular Risk Factors On Target Organ Injury And The Indirect Effect Mediated Through Blood Pressure Severity: Modifying Effect Of Chronic Kidney Disease
- Creators
- Carol Vincent - Wake Forest UniversityJessica F Campbell - Texas Children's HospitalJackson Londeree - Emory UniversityJason Misurac - University of IowaMaggie Murphy - University of KentuckyElizabeth Onugha - Baylor College of MedicineSandeep Riar - Emory UniversityChristine Sethna - North Shore Diabetes and Endocrine AssociatesSahar Siddiqui - Baylor College of MedicineDonald J Weaver - Levine Children's HospitalIkuyo Yamaguchi - Children's Hospital of OklahomaAndrew South - Wake Forest University
- Resource Type
- Abstract
- Publication Details
- Hypertension (Dallas, Tex. 1979), Vol.80(Suppl_1)
- DOI
- 10.1161/hyp.80.suppl_1.P197
- ISSN
- 0194-911X
- eISSN
- 1524-4563
- Language
- English
- Date published
- 09/2023
- Academic Unit
- Stead Family Department of Pediatrics; Nephrology, Dialysis and Transplantation
- Record Identifier
- 9984480348302771
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