Original investigations
Dialysis therapies
Hypertension in pediatric patients on long-term dialysis: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

https://doi.org/10.1053/j.ajkd.2004.11.006Get rights and content

Background: Elevated blood pressure (BP) is frequent in children on long-term dialysis therapy. However, the prevalence of hypertension and status of BP control in these patients are lacking. Using the North American Pediatric Renal Transplantation Cooperative Study database, we determined the prevalence of hypertension and assessed risk factors for elevated BP during long-term dialysis therapy in children. Methods: The study cohort included 3,743 patients (age, 0 to 21 years). Uncontrolled hypertension is defined as BP equal to or greater than age-, sex-, and height-specific 95th percentiles; controlled hypertension was considered in children who were administered antihypertensive medications, but had BP less than the 95th percentile. Results: A total of 76.6% of patients had either uncontrolled (56.9%) or controlled (19.7%) hypertension at baseline. Normotensive children at baseline had significant BP increases, whereas hypertensive children at baseline had significant BP decreases during the first year of dialysis therapy. BP did not change significantly after 1 year of dialysis therapy; 51% of patients had uncontrolled hypertension after 1 year of maintenance dialysis therapy. Logistic regression analysis shows that baseline hypertensive status and use of BP medications are both large significant risk factors for subsequent hypertension. Other risk factors include young age, acquired cause of renal failure, black race, initiation of dialysis therapy in 1992 to 1997, and hemodialysis as a mode of renal replacement therapy. Conclusion: Hypertension is very prevalent and difficult to control in children on dialysis therapy. Results also suggest that the initial months on maintenance dialysis therapy might be the window of opportunity when careful monitoring and aggressive management of hypertension would allow achieving BP control in these patients.

Section snippets

Methods

Data were obtained from the dialysis NAPRTCS database, which collects status information at the time of initiation of maintenance dialysis therapy (first 30 days of dialysis) and every 6 months thereafter. All data received for patients initiating dialysis therapy after January 1, 1992, through February 2004 were included in the analysis. The study cohort included 3,743 patients aged between 0 and 21 years. Data obtained at baseline included age, sex, race, primary renal diagnosis, dialysis

Results

At baseline, in the cohort of 3,743 children, the majority were male (55%) and white (48%); 24% were African American and 21% were Hispanic. Primary kidney diagnoses included structural anomalies/familial diseases (39%), glomerulonephritis/focal segmental glomerulosclerosis, systemic immunologic disease (30%), and others (31%). For 10% of children, baseline body mass index was at the 95th percentile or greater. The majority of patients (67.5%) entered peritoneal dialysis as renal replacement

Discussion

This retrospective analysis of pediatric patients from the large dialysis NAPRTCS database is the first pediatric study to report longitudinal changes in BP in children on maintenance dialysis therapy. There are very few studies evaluating BP during long-term dialysis therapy in children. One reason is that the majority of pediatric patients undergo kidney transplantation within the first year after entering dialysis therapy. Another reason is the difficulty of interpreting BP because of the

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Originally published online as doi:10.1053/j.ajkd.2004.11.006 on December 29, 2004.

The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) is a voluntary collaborative effort comprising more than 140 pediatric renal disease treatment centers in the United States, Canada, Mexico, and Costa Rica.

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