Achieved clinic blood pressure level and chronic kidney disease progression in children: a report from the Chronic Kidne
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ORIGINAL ARTICLE
Achieved clinic blood pressure level and chronic kidney disease progression in children: a report from the Chronic Kidney Disease in Children cohort Joseph T. Flynn 1,2
&
Megan K. Carroll 3 & Derek K. Ng 3 & Susan L. Furth 4,5 & Bradley A. Warady 6
Received: 14 June 2020 / Revised: 2 October 2020 / Accepted: 16 October 2020 # IPNA 2020
Abstract Background Control of hypertension delays progression of pediatric chronic kidney disease (CKD), yet few data are available regarding what clinic blood pressure (BP) levels may slow progression. Methods Longitudinal BP data from children in the Chronic Kidney Disease in Children cohort study who had hypertension or an auscultatory BP ≥ 90th percentile were studied. BP categories were defined as the maximum systolic or diastolic BP percentile (< 50th, 50th to 75th, 75th to 90th, and ≥ 90th percentile) with time-updated classifications corresponding to annual study visits. The primary outcome was time to kidney replacement therapy or a 30% decline in estimated glomerular filtration rate. Cox proportional hazard models described the effect of each BP category compared to BP ≥ 90th percentile. Results Seven hundred fifty-four participants (median age 9.9 years at study entry) met inclusion criteria; 65% were male and 26% had glomerular CKD. Any BP < 90th percentile was associated with a decreased risk of progression for those with glomerular CKD (hazard ratio (HR), 0.63; 95% CI, 0.28–1.39 (< 50th); HR, 0.59; 95% CI, 0.28–1.26 (50th–75th); HR, 0.40; 95% CI, 0.18–0.93 (75th–90th)). Similar results were found for those with non-glomerular CKD: any BP < 90th percentile was associated with decreased risk of progression (HR, 0.78; 90% CI, 0.49–1.25 (< 50th); HR, 0.53; 95% CI, 0.33–0.84 (50th–75th); HR, 0.71; 95% CI, 0.46–1.08 (75th–90th)). Conclusions Achieved clinic BP < 90th percentile was associated with slower CKD progression in children with glomerular or non-glomerular CKD. These data provide guidance for management of children with CKD in the office setting.
Keywords Hypertension . Chronic kidney disease . Glomerular filtration rate . Children . Adolescents . Cohort study
Introduction * Joseph T. Flynn [email protected] 1
Division of Nephrology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
2
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
3
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
4
Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
5
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
6
Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA
There is a growing body of evidence that hypertension is a major contributor to progression in pediatric patients with established chronic kidney disease (CKD) [1]. In a study designed to test the effects of a low-protein versus conventional diet on CKD progressi
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