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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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      Hypertension and Future Cardiovascular Health in Pediatric End-Stage Renal Disease Patients

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      Publication date (Electronic):
      Journal: Blood Purification
      Publisher: S. Karger AG
      Keywords: Cardiovascular disease, Dialysis, Blood pressure, Children, Adolescents, Hypertension

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          Abstract

          Background: There are now numerous studies that have documented an increased risk of cardiovascular morbidity and mortality in young adults who had childhood-onset end-stage renal disease (ESRD). Since the number of such patients surviving to adulthood is increasing, strategies to reduce this risk are urgently needed. Methods: The various risk factors contributing to adult cardiovascular disease in this population will be reviewed, with an emphasis on hypertension and its control. Data demonstrating the prevalence of hypertension in childhood chronic kidney disease as well as the results of improved blood pressure control in ESRD will also be presented. Conclusions: Hypertension is exceedingly common in pediatric ESRD patients and frequently poorly controlled. Efforts to improve blood pressure control in this patient population could potentially reduce future cardiovascular morbidity and mortality.

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          Masked hypertension associates with left ventricular hypertrophy in children with CKD.

          Susan Furth, Tom Hansen, Silvia Cohn … (2009)
          Left ventricular hypertrophy (LVH) associates with increased risk for cardiovascular disease. Hypertension leads to LVH in adults, but its role in the pathogenesis of LVH in children is not as well established. To examine left ventricular mass and evaluate factors associated with LVH in children with stages 2 through 4 chronic kidney disease (CKD), we analyzed cross-sectional data from children who had baseline echocardiography (n = 366) and underwent ambulatory BP monitoring (n = 226) as a part of the observational Chronic Kidney Disease in Children (CKiD) cohort study. At baseline, 17% of children had LVH (11% eccentric and 6% concentric) and 9% had concentric remodeling of the left ventricle. On the basis of a combination of ambulatory and casual BP assessment (n = 198), 38% of children had masked hypertension (normal casual but elevated ambulatory BP) and 18% had confirmed hypertension (both elevated casual and ambulatory BP). There was no significant association between LVH and kidney function. LVH was more common in children with either confirmed (34%) or masked (20%) hypertension compared with children with normal casual and ambulatory BP (8%). In multivariable analysis, masked (odds ratio 4.1) and confirmed (odds ratio 4.3) hypertension were the strongest independent predictors of LVH. In conclusion, casual BP measurements alone are insufficient to predict the presence of LVH in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risk in children with CKD.
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            Cardiovascular mortality in children and young adults with end-stage kidney disease.

            Daniel C. Carroll, Robert Port, R Wolfe … (2002)
            To analyze cardiovascular death in a national end-stage renal disease (ESRD) population. This retrospective, observational study with data from the US Renal Data Systems analyzed 1380 deaths from 1990 to 1996 among patients who started ESRD therapy as children and died before 30 years of age. Percentage of cardiac deaths (n = 311) varied by age and was higher among black patients (0-4 years, 36%; 5-9 years, 18%; 10-14 years, 35%; 15-19 years, 22%; 20-30 years, 32%) than white patients (18%, 12%, 17%, 14%, and 23%, respectively). Among black patients, cardiac deaths occurred in 11% of transplant recipients, 34% of dialysis patients, and among white patients 9% and 25%, respectively. Black patients were 1.6 times more likely to die of a cardiac death (P <.001) than white patients. Transplant recipients had 78% lower risk of cardiac death than dialysis patients (odds ratio = 0.22; P =.0001). The cardiac death rate among dialysis patients was 21.4 per 1000 patient-years in black patients compared with 20.5 in white patients. Transplantation cardiac death rates were lower in black patients, 2.1 per 1000 patient-years, and 1.3 in white patients. Cardiovascular death accounts for 23% of pediatric and young adult ESRD deaths. Black patients and dialysis patients are at higher risk of a cardiac death compared with white patients and transplant recipients. Further studies are needed to identify risk factors associated with cardiovascular death in patients with ESRD.
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              Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study.

              Claudia Flynn, Susan Furth, … (2008)
              To characterize the distribution of blood pressure (BP), prevalence, and risk factors for hypertension in pediatric chronic kidney disease, we conducted a cross-sectional analysis of baseline BPs in 432 children (mean age 11 years; 60% male; mean glomerular filtration rate 44 mL/min per 1.73 m(2)) enrolled in the Chronic Kidney Disease in Children cohort study. BPs were obtained using an aneroid sphygmomanometer. Glomerular filtration rate was measured by iohexol disappearance. Elevated BP was defined as BP >or=90th percentile for age, gender, and height. Hypertension was defined as BP >or=95th percentile or as self-reported hypertension plus current treatment with antihypertensive medications. For systolic BP, 14% were hypertensive and 11% were prehypertensive (BP 90th to 95th percentile); 68% of subjects with elevated systolic BP were taking antihypertensive medications. For diastolic BP, 14% were hypertensive and 9% were prehypertensive; 53% of subjects with elevated diastolic BP were taking antihypertensive medications. Fifty-four percent of subjects had either systolic or diastolic BP >or=95th percentile or a history of hypertension plus current antihypertensive use. Characteristics associated with elevated BP included black race, shorter duration of chronic kidney disease, absence of antihypertensive medication use, and elevated serum potassium. Among subjects receiving antihypertensive treatment, uncontrolled BP was associated with male sex, shorter chronic kidney disease duration, and absence of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. Thirty-seven percent of children with chronic kidney disease had either elevated systolic or diastolic BP, and 39% of these were not receiving antihypertensives, indicating that hypertension in pediatric chronic kidney disease may be frequently under- or even untreated. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may improve BP control in these patients.
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                Author and article information

                Journal
                Journal ID (publisher-id): BPU
                Journal ID (nlm-ta): Blood Purif
                Journal ID (doi): 10.1159/issn.0253-5068
                Title: Blood Purification
                Publisher: S. Karger AG
                ISSN (Print): 0253-5068
                ISSN (Electronic): 1421-9735
                Publication date Subscription-year: 2012
                Publication date (Print): March 2012
                Publication date (Electronic): 20 January 2012
                Volume: 33
                Issue: 1-3
                Pages: 138-143
                Affiliations
                University of Washington School of Medicine, and Pediatric Hypertension Program, Seattle Children’s Hospital, Seattle, Wash., USA
                Author notes
                *Prof. Joseph T. Flynn, MD, MS, Division of Nephrology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 (USA), Tel. +1 206 987 2524, E-Mail joseph.flynn@seattlechildrens.org
                Article
                Publisher ID: 334140 Other ID: Blood Purif 2012;33:138–143
                DOI: 10.1159/000334140
                PubMed ID: 22269342
                SO-VID: 136c4765-54fd-4720-928d-bd7c7c718268
                Copyright © © 2012 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 1, Tables: 1, Pages: 6
                Categories
                Subject: Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Cardiovascular disease,Dialysis,Blood pressure,Children,Adolescents,Hypertension
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Cardiovascular disease, Dialysis, Blood pressure, Children, Adolescents, Hypertension

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