MO076LONGITUDINAL CHANGES AND OUTCOME OF HIGH BLOOD PRESSURE IN EUROPEAN CHILDREN ON RENAL REPLACEMENT THERAPY

Abstract

Abstract Background and Aims Few studies have focused on trends of hypertension (HTN) and status of blood pressure (BP) control over time in children on renal replacement therapy (RRT). In this study, we aimed to evaluate the 5-year trend in BP antihypertensive medications (AHs) use, as well as the association between HTN and mortality among RRT patients enrolled within the ESPN/ERA-EDTA Registry. Method 25.223 BP measurements from 5.032 patients who started RRT before 20 years of age, between 2007-2016, were included. Mixed models were used to analyse trends of BP, the JointPoint regression to assess prevalence of uncontrolled HTN (uHTN) over time, and multivariable Cox proportional hazard models to evaluate association of BP with mortality. Results Mean systolic BP (SBP) at RRT initiation was 1.66(+0.15), 1.05(+0.15) and 1.09(+0.08) SDS in HD, PD and transplanted (Tx) patients, respectively, while it was 1.41(+0.19), 1.12(+0.18), and 0.79(+0.06) SDS in the corresponding RRT categories after 5 years. Patients on HD showed a significant decrease in the prevalence of uHTN over time (57.1% at dialysis start vs 41.4% after 5 years; annual percentage change [APC] -4%; 95% CI: -5.7;-2.2; p<0.05), coupled with a significant reduction in AHs use (APC -3.5%; 95% CI: -6.7;-0.2). PD patients showed a similar reduction in uHTN prevalence (APC -4.9%; 95% CI: -7.2;-2.6; p<0.05), but a significant increase in AHs use (APC +3.6%; 95% CI: 0.6;6.6; p<0.05). After 5 years, Tx patients showed a significant reduction in both prevalence of uHTN (APC -4.8%; 95% CI: -7.8;-1.7; p<0.05) and use of AHs (APC -2.2%; 95% CI: -4.1;-0.3%; p<0.05). Having uHTN was not associated with mortality (HR 0.95; 95% CI: 0.68-1.33). Conclusion A more adequate control of BP over time seemed to be obtained in children on RRT. Findings in PD patients suggest that this requires a progressive increase in the use of AHs.