Hypertension in dialysed children: the prevalence and therapeutic approach in Poland—a nationwide survey

Tkaczyk, Marcin; Nowicki, Michał; Bałasz-Chmielewska, Irena; Boguszewska-Bączkowska, Hanna; Drożdż, Dorota; Kołłątaj, Barbara; Jarmoliński, Tomasz; Jobs, Katarzyna; Kiliś‐Pstrusińska, Katarzyna; Leszczyńska, Beata; Makulska, Irena; Runowski, Dariusz; Stankiewicz, R; Szczepańska, Maria; Wierciński, Ryszard; Grenda, Ryszard; Kanik, Andrzej; Pietrzyk, Jacek A; Roszkowska‐Blaim, Maria; Szprynger, Krystyna; Zachwieja, Jacek; Zajaczkowska, M; Zoch-Zwierz, W; Zwołińska, Danuta; Żurowska, Aleksandra

doi:10.1093/ndt/gfi280

Cited by 54 publications

(34 citation statements)

References 19 publications

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“…The development of elevated LVMI within this population was also found to be associated with changes in both systolic and diastolic cardiac function. Similar to previous studies [10,11,26] roughly one-quarter of the patients in this study manifested persistent hypertension despite being on routine dialysis. Although the longterm ramifications of uncontrolled hypertension within the pediatric dialysis population have not been comprehensively studied, it would be expected to have a deleterious effect on cardiovascular health.…”

Section: Discussionsupporting

confidence: 90%

Association between left ventricular mass index and cardiac function in pediatric dialysis patients

et al. 2011

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Section: Discussionsupporting

confidence: 90%

Association between left ventricular mass index and cardiac function in pediatric dialysis patients

et al. 2011

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“…Hypertension in children with CKD requiring renal replacement therapy is found in 55-79% of patients, including 56-79% treated with haemodialysis, 54-75% treated with peritoneal dialysis (in Poland, 56% and 54%, respectively), as well as around 66% of patients after kidney transplantation [48][49][50]. It should be noted that approximately 20% of dialyzed children with hypertension are untreated, and among those undergoing treatment, nearly 75% of children have poorly controlled hypertension [48].…”

Section: Hypertension In Patients On Dialysis Therapymentioning

confidence: 99%

“…The main risk factor for AH in chronically dialysed children is overhydration and excessive salt supply. Other risk factors are: young age of the child (< 6 years), black race, female gender, acquired underlying kidney disease, anaemia and the duration of dialysis therapy (the longer the time, the smaller the percentage of patients with high blood pressure) [48][49][50][51][52]. The most important element of AH prevention and treatment in children undergoing dialysis is a correct assessment of the hydration status and achieving dry body weight [53][54][55][56][57].…”

Section: Hypertension In Patients On Dialysis Therapymentioning

confidence: 99%

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Litwin

Niemirska

Obrycki

et al. 2018

Arterial Hypertension

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Presented recommendations are an extended and actualized version of paediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendations and Recommendations of Children's Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Pediatrics have been discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born before 33 weeks of gestation published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account.

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“…It is often difficult to control HTN in CKD. Irrespective of anti-hypertensive medications used, HTN cannot be controlled in more than 50% of children with end-stage renal disease (ESRD) [27][28][29] . Following treatment with combination antihypertensive medications, only 56% of hypertensive CKD children were able to achieve a BP target of < 50 th percentile for age, gender and height [3] .…”

Section: Epidemiology Of Htn In Ckdmentioning

confidence: 99%

Pre-treatment considerations in childhood hypertension due to chronic kidney disease

Olowu

2015

WJN

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Hypertension (HTN) develops very early in childhood chronic kidney disease (CKD). It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start antihypertensive medication when blood pressure (BP) is persistently > 90 th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcification, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-inflammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.

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Hypertension in dialysed children: the prevalence and therapeutic approach in Poland—a nationwide survey

Abstract: We conclude that the incidence of hypertension in dialysis children in Poland is high (55%). The effectiveness of antihypertensive treatment is rather low (58%) and the choice of drugs is limited.

Cited by 54 publications

References 19 publications

Association between left ventricular mass index and cardiac function in pediatric dialysis patients

Association between left ventricular mass index and cardiac function in pediatric dialysis patients

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Pre-treatment considerations in childhood hypertension due to chronic kidney disease

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