Prospective study of modifiable risk factors of arterial hypertension and left ventricular hypertrophy in pediatric patients on hemodialysis
Introduction - Fluid and salt overload in patients on dialysis result in high blood pressure (BP), left ventricular hypertrophy (LVH) and hemodynamic instability, resulting in cardiovascular morbidity. - Methods - Analysis of 910 pediatric patients on maintenance hemodialysis/hemodiafiltration (HD/H...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
June 2024
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| In: |
Kidney international. Reports
Year: 2024, Volume: 9, Issue: 6, Pages: 1694-1704 |
| ISSN: | 2468-0249 |
| DOI: | 10.1016/j.ekir.2024.03.016 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.ekir.2024.03.016 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2468024924015870 
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| Author Notes: | Dagmara Borzych-Dużałka, Rukshana Shroff, Bruno Ranchin, Yihui Zhai, Fabio Paglialonga, Jameela A. Kari, Yo H. Ahn, Hazem S. Awad, Reyner Loza, Nakysa Hooman, Robin Ericson, Dorota Drożdz, Amrit Kaur, Sevcan A. Bakkaloglu, Charlotte Samaille, Marsha Lee, Stephanie Tellier, Julia Thumfart, Marc Fila, Bradley A. Warady, Franz Schaefer and Claus P. Schmitt |
| Summary: | Introduction - Fluid and salt overload in patients on dialysis result in high blood pressure (BP), left ventricular hypertrophy (LVH) and hemodynamic instability, resulting in cardiovascular morbidity. - Methods - Analysis of 910 pediatric patients on maintenance hemodialysis/hemodiafiltration (HD/HDF), prospectively followed-up with 2758 observations recorded every 6-months in the International Pediatric Hemodialysis Network (IPHN). - Results - Uncontrolled hypertension was present in 55% of observations, with 27% of patients exhibiting persistently elevated predialysis BP. Systolic and diastolic age- and height-standardized BP (BP-SDS) were independently associated with the number of antihypertensive medications (odds ratio [OR] = 1.47, 95% confidence interval 1.39-1.56, 1.36 [1.23-1.36]) and interdialytic weight gain (IDWG; 1.19 [1.14-1.22], 1.09 [1.06-1.11]; all P < 0.0001). IDWG was related to urine output (OR = 0.27 [0.23-0.32]) and dialysate sodium (dNa; 1.06 [1.01-1.10]; all P < 0.0001). The prevalence of masked hypertension was 24%, and HD versus HDF use was an independent risk factor of elevated age- and height-standardized mean arterial pressure (MAP-SDS) (OR = 2.28 [1.18-4.41], P = 0.01). Of the 1135 echocardiograms, 51% demonstrated LVH. Modifiable risk factors included predialysis systolic BP-SDS (OR = 1.06 [1.04-1.09], P < 0.0001), blood hemoglobin (0.97 [0.95-0.99], P = 0.004), HD versus HDF modality (1.09 [1.02-1.18], P = 0.01), and IDWG (1.02 [1.02-1.03], P = 0.04). In addition, HD modality increased the risk of LVH progression (OR = 1.23 [1.03-1.48], P = 0.02). Intradialytic hypotension (IDH) was prevalent in patients progressing to LVH and independently associated with predialysis BP-SDS below 25th percentile, lower number of antihypertensives, HD versus HDF modality, ultrafiltration (UF) rate, and urine output, but not with dNa. - Conclusion - Uncontrolled hypertension and LVH are common in pediatric HD, despite intense pharmacologic therapy. The outcome may improve with use of HDF, and superior anemia and IDWG control; the latter via lowering dNa, without increasing the risk of IDH. |
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| Item Description: | Online verfügbar 18 March 2024, Version des Artikels 5 June 2024 Gesehen am 29.01.2025 |
| Physical Description: | Online Resource |
| ISSN: | 2468-0249 |
| DOI: | 10.1016/j.ekir.2024.03.016 |