Renal and Patients’ Survival in Children with Hypertensive Chronic Kidney Disease

Olowu Wa

doi:10.16966/2380-5498.110

Abstract

The impact of hypertension on renal and patients’ survival was retrospectively determined in children with chronic kidney disease (CKD). Seventy-seven of 154 CKD patients were hypertensive with 23 (30%) and 54 (70.0%) having stages I (123.0 ± 12.5/ 82.4 ± 10.6 mmHg) and II hypertension (161.0 ± 32.3/111.0 ± 23.0 mmHg), respectively. Seventy percent received two or more anti-hypertensive medications to achieve satisfactory blood pressure (BP) control. BP control was good, fair and poor in 43 (56.0%), 18 (23.4%), and 16 (20.6%) patients, respectively. Post-treatment BP in hypertensive CKD (hCKD) with good control was similar to normotensive CKD (nCKD), p=0.541. One/5 years renal survivals in nCKD (97.0/80.0%) were similar to hCKD with good BP control (96.2/63.0%, Log-rank p=0.362). nCKD, however, demonstrated significantly better one/five years renal survival (97.0/80.0%) than hCKD with fair (75.0/25.0%, p=0.014) and poor BP control (50.0/0.00%, p=0.003). hCKD with good BP control survived (66.7%) significantly better than hCKD with either fair (24.1%; p=0.002) or poor (0.0%; p=0.000) control. nCKD (90.4%) and hCKD with good BP control (66.7%) survived similarly, p=0.198. Cumulative mortality was significantly higher in hCKD (62.4%) than in nCKD (9.5%) [Hazard ratio: 0.54, 95% CI: 0.35-0.83, p=0.005]. Stage II occurred more frequently than stage I hypertension. Hypertension is a significant risk factor for poor renal survival and mortality in childhood CKD. Renal and patients’ survival was significantly better in hCKDs with post-treatment BP level ≤ 50th percentile compared to hCKDs with post-treatment BP level >50th percentile for age, gender, and height.

Highlights

Compared to the normal paediatric and adolescents’ population [13], the prevalence of hypertension (HTN) in childhood chronic kidney disease (CKD) is frequently higher [4,5,6,7]
When blood pressure (BP) is consistently above the 90th percentile for age, gender, and height in non-dialyzing hypertensive CKD children, it is advised that antihypertensive medications should be started to limit disease progression and comorbidities [16]
It was recommended that the therapeutic BP target in such children, those with proteinuria, should be less than the 50th percentile for age, gender and height unless achieving this target is limited by signs or symptoms of hypotension

Summary

Introduction

Compared to the normal paediatric and adolescents’ population [13], the prevalence of hypertension (HTN) in childhood chronic kidney disease (CKD) is frequently higher [4,5,6,7]. HTN develops very early in childhood CKD [9,10] and has been associated with rapid CKD progression and significant target-organ damage. When blood pressure (BP) is consistently above the 90th percentile for age, gender, and height in non-dialyzing hypertensive CKD (hCKD) children, it is advised that antihypertensive medications should be started to limit disease progression and comorbidities [16]. It was recommended that the therapeutic BP target in such children, those with proteinuria, should be less than the 50th percentile for age, gender and height unless achieving this target is limited by signs or symptoms of hypotension. Apart from escalating disease progression, HTN is an established risk factor for comorbidities like cardiovascular abnormalities, proteinuria, seizures, and stroke [11]

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Results

Conclusion