Hypertension Very Common Among Children on Long-Term Dialysis

New research indicates that most children about to begin long-term dialysis have hypertension and that the prevalence does not decrease much during follow-up. The findings, which appear in the American Journal of Kidney Diseases for February, are based on a study of 3743 pediatric patients entered in the North American Pediatric Renal Transplantation Cooperative Study database.

At baseline, the prevalence of uncontrolled and controlled hypertension was 56.9% and 19.7%, respectively, co-authors Dr. Mark Mitsnefes and Dr. Donald Stablein, from Cincinnati Children’s Hospital Medical Center in Ohio, note.

During the first year of dialysis, blood pressure rose significantly in normotensive children and fell significantly in hypertensive children, the researchers point out. After 1 year of dialysis, however, no significant changes in blood pressure were observed and about 50% of patients continued to have hypertension on long-term follow-up.

Strong predictors of hypertension on long-term follow-up included hypertension at baseline and the use of blood pressure medications. Young age, acquired cause of renal failure, black race, and hemodialysis were also linked to an increased risk of hypertension.

"Hypertension is very prevalent and difficult to control in children on dialysis therapy," the authors state. "The results also suggest that the initial months on maintenance dialysis therapy might be the window of opportunity when careful monitoring and aggressive management of hypertension would allow achieving BP control in these patients."
Am J Kidney Dis 2005;45:309-315.