PREVALENCE OF MASKED HYPERTENSION IN CHILDREN AND YOUNG ADULTS WITH CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: Hypertension is a common complication and an important risk factor for adverse cardiovascular outcomes in patients with chronic kidney disease (CKD). Studies characterizing blood pressure status on young renal transplant recipients and young dialysis patients using ambulatory blood pressure monitoring are limited and report different prevalence rates. The aim of this meta-analysis was to estimate the prevalence of white-coat and masked hypertension in children and young adults with chronic kidney disease. Design and method: We performed a systematic review and meta-analysis of observational studies assessing the prevalence of blood pressure status using ambulatory blood pressure monitoring in children and young adults with chronic kidney disease. Records were identified by search in Medline, Scopus, and CENTRAL databases and sources of grey literature until December 2021. We conducted a random-effects meta-analysis of proportions (double arcsine transformation). Results: Overall, we included 10 studies with a total of 1140 children and young adults with CKD and a mean age of 13.79 ± 4.35 years. 301 and 76 patients presented masked hypertension and white-coat hypertension, respectively. We estimated an overall pooled masked HTN prevalence of 27% (95% CI: 18% to 36%, I2 = 87%) and an overall pooled prevalence of white-coat HTN of 6% (95% CI: 3% to 9%, I2 = 78%) (figure 2). Among renal transplant recipients masked HTN had a prevalence of 29% (95% CI: 14% to 47%, I2 = 86%). Further assessment of heterogeneity was qualitatively conducted. Conclusions: Masked hypertension is significantly prevalent in children and young adults with CKD, thereby warranting clinical attention when assessing cardiovascular risk in this population. Ambulatory blood pressure monitoring is of high importance when assessing blood pressure status in children with CKD.