Effect of hypertension and antihypertensive medications on residual renal function in children treated with chronic peritoneal dialysis

Abstract

PurposeTo evaluate the effect of hypertension (HTN) and antihypertensive medications (AHM) on residual renal function (RRF) in children on CAPD and APD. Material/methodsWe retrospectively evaluated underlying kidney disease, systolic and diastolic blood pressure (SBP/DBP), presence and control of HTN (SBP/DBP≥95th percentile), AHM, RRF (daily diuresis, residual glomerular filtration rate [rGFR]), biochemical parameters, BMI Z-score, and dialysis parameters during 12-month follow-up in 87 children (38 CAPD, 49 APD) aged 10.22±4.31 years. The rate of RRF loss was expressed as absolute and relative [%] reduction. ResultsAt baseline, HTN was found in 74.7% patients (CAPD/APD: 84.2%/67.3%, P=0.06), most commonly in HUS and least frequently in CAKUT. The proportion of CAPD/APD patients with poorly controlled HTN was 70.0%/63.3% (P=0.50). Relative daily diuresis loss in children with uncontrolled HTN was higher (P=0.017) compared to children with SBP/DBP <95th percentile. No effect of AHM on the rate of RRF loss was found. In multivariate analysis, absolute daily diuresis loss was related to baseline diuresis (β=−0.30, P<0.001) and proteinuria (β=−0.31, P=0.004); absolute rGFR loss to baseline rGFR (β=−0.73, P<0.001) and glucose load after 12 months (β=−0.36, P=0.02); relative daily diuresis loss to mean BMI Z-score (β=−0.44, P=0.04); and relative rGFR to baseline rGFR (β=−0.37, P<0.001) and SBP percentile (β=−0.21, P=0.045). Conclusions1.Maintaining blood pressure <95th percentile helps preserve RRF in children with ESRD treated with peritoneal dialysis.2.Risk factors for rapid RRF loss in children on CAPD/APD include elevated SBP, high baseline diuresis/rGFR, proteinuria, and high glucose load in the dialysis fluid.