BACKGROUND: Control of blood pressure (BP) following renal transplantation may improve allograft and patient survival. Our aims were (i) to describe the distribution of BP and the prevalence of systolic and/or diastolic hypertension in children over the first 5 years following renal transplantation and (ii) to evaluate clinical risk factors and centre-specific factors associated with hypertension in this population. METHODS: We conducted a retrospective case note review of all current paediatric kidney transplant patients in the UK, with data collected at 6 months, 1, 2 and 5 years following transplantation in subjects with hypertension (systolic and/or diastolic BP > 95th > ) and non-hypertensive subjects BP ≤ 95th > . RESULTS: In total, 27.3% (117/428), 27.6% (118/428), 26.0% (95/365) and 25.6% (50/195) of the patients were hypertensive (systolic and/or diastolic BP > 95th > ) at 6 months, 1, 2 and 5 years following transplantation, respectively. A total of 58.4% of the patients at 6 months, 52.8% at 1 year, 48.2% at 2 years and 48.2% at 5 years were receiving anti-hypertensive therapy, of whom 31.6-36.6% remained hypertensive. When subjects were identified as being hypertensive, on anti-hypertensive medication or had untreated hypertension (systolic and/or diastolic BP > 95th > ), 66.4, 61.0, 56.4 and 55.9% of patients were hypertensive at 6 months, 1, 2 and 5 years, respectively. In a multivariate model, odds ratios for systolic hypertension were 4.16 (deceased versus living donor), 2.65 (lowest versus highest quartile of height z-score) and 2.07 (if on anti-hypertensive; yes versus no). There was significant variation in prevalent rates of hypertension between centres (P < 0.0001) that remained significant (P = 0.003) after adjustment for all the factors in the multivariate model. CONCLUSIONS: Control of BP after kidney transplantation remains sub-optimal in paediatric centres in the UK. Just over 25% of patients remain hypertensive 5 years following transplantation. Significant differences between centres remain unexplained and may reflect differences in assessment and management of hypertension.
BACKGROUND: Control of blood pressure (BP) following renal transplantation may improve allograft and patient survival. Our aims were (i) to describe the distribution of BP and the prevalence of systolic and/or diastolic hypertension in children over the first 5 years following renal transplantation and (ii) to evaluate clinical risk factors and centre-specific factors associated with hypertension in this population. METHODS: We conducted a retrospective case note review of all current paediatric kidney transplant patients in the UK, with data collected at 6 months, 1, 2 and 5 years following transplantation in subjects with hypertension (systolic and/or diastolic BP > 95th > ) and non-hypertensive subjects BP ≤ 95th > . RESULTS: In total, 27.3% (117/428), 27.6% (118/428), 26.0% (95/365) and 25.6% (50/195) of the patients were hypertensive (systolic and/or diastolic BP > 95th > ) at 6 months, 1, 2 and 5 years following transplantation, respectively. A total of 58.4% of the patients at 6 months, 52.8% at 1 year, 48.2% at 2 years and 48.2% at 5 years were receiving anti-hypertensive therapy, of whom 31.6-36.6% remained hypertensive. When subjects were identified as being hypertensive, on anti-hypertensive medication or had untreated hypertension (systolic and/or diastolic BP > 95th > ), 66.4, 61.0, 56.4 and 55.9% of patients were hypertensive at 6 months, 1, 2 and 5 years, respectively. In a multivariate model, odds ratios for systolic hypertension were 4.16 (deceased versus living donor), 2.65 (lowest versus highest quartile of height z-score) and 2.07 (if on anti-hypertensive; yes versus no). There was significant variation in prevalent rates of hypertension between centres (P < 0.0001) that remained significant (P = 0.003) after adjustment for all the factors in the multivariate model. CONCLUSIONS: Control of BP after kidney transplantation remains sub-optimal in paediatric centres in the UK. Just over 25% of patients remain hypertensive 5 years following transplantation. Significant differences between centres remain unexplained and may reflect differences in assessment and management of hypertension.
Authors: Gilad Hamdani; Edward J Nehus; Coral D Hanevold; Judith Sebestyen Van Sickle; Robert Woroniecki; Scott E Wenderfer; David K Hooper; Douglas Blowey; Amy Wilson; Bradley A Warady; Mark M Mitsnefes Journal: Transplantation Date: 2017-01 Impact factor: 4.939
Authors: Rizky I Sugianto; Bernhard M W Schmidt; Nima Memaran; Ali Duzova; Rezan Topaloglu; Tomas Seeman; Sabine König; Luca Dello Strologo; Luisa Murer; Zeynep Birsin Özçakar; Martin Bald; Mohan Shenoy; Anja Buescher; Peter F Hoyer; Michael Pohl; Heiko Billing; Jun Oh; Hagen Staude; Martin Pohl; Gurkan Genc; Günter Klaus; Caner Alparslan; Ryszard Grenda; Jacek Rubik; Kai Krupka; Burkhard Tönshoff; Elke Wühl; Anette Melk Journal: Pediatr Nephrol Date: 2019-12-07 Impact factor: 3.714
Authors: Matthew R Weir; Ellen D Burgess; James E Cooper; Andrew Z Fenves; David Goldsmith; Dianne McKay; Anita Mehrotra; Mark M Mitsnefes; Domenic A Sica; Sandra J Taler Journal: J Am Soc Nephrol Date: 2015-02-04 Impact factor: 10.121
Authors: Michael E Seifert; Devesh S Dahale; Margret Kamel; Pamela D Winterberg; Gina-Marie Barletta; Craig W Belsha; Abanti Chaudhuri; Joseph T Flynn; Rouba Garro; Roshan P George; Jens W Goebel; David B Kershaw; Debora Matossian; Jason Misurac; Corina Nailescu; Christina R Nguyen; Meghan Pearl; Ari Pollack; Cozumel S Pruette; Pamela Singer; Judith S VanSickle; Priya Verghese; Bradley A Warady; Andrew Warmin; Patricia L Weng; Larysa Wickman; Amy C Wilson; David K Hooper Journal: Pediatrics Date: 2020-06-09 Impact factor: 7.124