Hypertension in Children with Chronic Kidney Disease

Abstract

Elevated blood pressure (BP) is a common clinical issue in adults and children with chronic kidney disease (CKD). In adults, hypertension (HTN) is an independent risk factor for stroke, myocardial infarction, congestive heart failure, aneurysms, and peripheral artery disease [1]. HTN is also a common cause of CKD in adults and is associated with a shortened life expectancy [2]. Fortunately, the long-term cardiovascular effects of HTN are not often realized during childhood, but there is substantial evidence that the pathological processes leading to cardiovascular disease are present and more advanced in children with CKD who are hypertensive [3,4]. Young adults with childhood-onset CKD have an excessive prevalence of arteriopathy demonstrated by an increase in coronary artery calcifications and intima-media thickness of the carotid arteries (cIMT) [5]. In children with more advanced renal disease requiring renal replacement therapy, the cardiovascular mortality rates are 1000-fold higher than the general population [6]. In addition to traditional risk factors for cardiovascular disease such as HTN, dyslipidemia, altered glucose tolerance, and obesity, the risk for cardiovascular disease may be amplified in children with CKD due to a high prevalence of other possible risk factors that include hyperparathyroidism, hyperhomocysteinemia, hyperuricemia, calcium phosphate overload, and micro-inflammation [3,4,7]. This chapter focuses on the epidemiology, clinical manifestations, pathophysiology, and management of HTN in children with CKD. EpidemiologyAccurate BP measurement in children with CKD is crucial to providing optimal clinical care and conducting meaningful research related to the impact of BP on targeted outcomes. The measurement of BP in children is influenced by many