Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS).
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.