Demographics of blood pressure and hypertension in children on renal replacement therapy in Europe

Abstract

Hypertension is a well-known complication in children on renal replacement therapy and an important risk factor for cardiovascular disease in later life. In order to define the prevalence of and risk factors for hypertension among children, we enrolled 3337 pediatric patients from 15 countries in the ESPN/ERA-EDTA Registry of whom 464 were on hemodialysis, 851 on peritoneal dialysis, and 2023 had received a renal allograft. Hypertension was defined as either systolic or diastolic blood pressures in the 95th percentile or greater for age, height, and gender or use of antihypertensive medication. Analyses were adjusted for age, gender, duration, and modality of renal replacement therapy. In 10 countries in which information on the use of antihypertensive medication was available, hypertension was present in over two-thirds of hemodialysis, peritoneal dialysis, or transplant patients. Blood pressure values above the 95th percentile were significantly more prevalent in very young patients (under 3 years) compared to 13- to 17-year olds (odds ratio 2.47), during the first year compared to over 5 years of renal replacement therapy (odds ratio 1.80), and in patients on hemodialysis compared to transplant recipients or those on peritoneal dialysis (odds ratios of 2.48 and 1.59, respectively). Over time, mean blood pressures decreased in both hemodialysis and transplant patients, but not in peritoneal dialysis patients. Hence, our findings highlight the extent of the problem of hypertension in children with end-stage renal disease in Europe.

Decreased Arterial Elasticity in Children With Nondialysis Chronic Kidney Disease Is Related to Blood Pressure and Not to Glomerular Filtration Rate

“…29,30 In children with CKD, BP control deteriorates with worsening renal function, 31,32 and both BP and BMI increase after transplantation from pretransplantation levels. [33][34][35][36] We would suggest, therefore, that persistently, high BP and BMI in children with predialysis CKD are likely to lead to increased functional stiffness of the carotid artery. BP reduction may be an effective means to protect against arterial stiffening or remodeling in children with CKD and hypertension that persists into adulthood.…”

Assessment and Management of Hypertension in Patients on Dialysis

“…In the latter study, demographic factors such as young age and black race and treatment factors such as prescription of antihypertensive medications were also identified as risk factors for poorly controlled hypertension. More recent data from the European Registry for Children on Renal Replacement Therapy on BP control among pediatric ESRD patients in Europe, including patients receiving HD, PD, and postrenal transplant, confirmed the high rate of hypertension in 183 Among dialysis patients, younger age, recent dialysis initiation, and HD modality were the most important risk factors for hypertension. 183 Of note, all of these studies are notable for their reliance upon registry data; thus, there is limited information available on the technique and/or frequency of BP measurement, or the goals of hypertension management.…”

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

“…Hypertension in children with CKD requiring renal replacement therapy is found in 55-79% of patients, including 56-79% treated with haemodialysis, 54-75% treated with peritoneal dialysis (in Poland, 56% and 54%, respectively), as well as around 66% of patients after kidney transplantation [48][49][50]. It should be noted that approximately 20% of dialyzed children with hypertension are untreated, and among those undergoing treatment, nearly 75% of children have poorly controlled hypertension [48].…”

“…The main risk factor for AH in chronically dialysed children is overhydration and excessive salt supply. Other risk factors are: young age of the child (< 6 years), black race, female gender, acquired underlying kidney disease, anaemia and the duration of dialysis therapy (the longer the time, the smaller the percentage of patients with high blood pressure) [48][49][50][51][52]. The most important element of AH prevention and treatment in children undergoing dialysis is a correct assessment of the hydration status and achieving dry body weight [53][54][55][56][57].…”