Hypertension in the Pediatric Kidney Transplant Recipient

Charnaya, Olga; Moudgil, Asha

doi:10.3389/fped.2017.00086

Cited by 17 publications

(29 citation statements)

References 109 publications

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“…In this cohort of 249 patients who started RRT in childhood and survived into adulthood (follow-up of 25.5 years), a clear decrease in CV mortality along with strict CV management and reversal of CV risk factors was observed [30,31]. A review published in 2017 describes the under-recognised and under-treated burden of hypertension in transplant patients [37]. In addition another study has reported on contradicting guidelines and differences in policies and treatment of hypertension in Dutch paediatric transplant patients [38].…”

Section: Conclusion and Clinical Implicationsmentioning

confidence: 96%

Long-term all-cause mortality and cardiovascular outcomes in Scottish children after initiation of renal replacement therapy: a national cohort study

et al. 2019

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Background Data on long-term outcomes in children who have received renal replacement therapy (RRT) for end-stage renal disease are limited. Methods We studied long-term survival and incidence of fatal and nonfatal cardiovascular disease (CVD) events and determinants of these outcomes in children who initiated RRT between 1961 and 2013 using data from the Scottish Renal Registry (SRR). Linkage to morbidity records was available from 1981. Results A total of 477 children of whom 55% were boys, almost 50% had congenital urinary tract disease (CAKUT), 10% received a transplant as the first mode of RRT and almost 60% were over 11 years of age at start of RRT were followed for a median of 17.8 years (interquartile range (IQR) 8.7-26.6 years). Survival was 87.3% (95% confidence interval (CI) 84.0-90.1) at 10 years and 77.6% (95% CI 73.3-81.7) at 20 years. During a median follow-up of 14.96 years (IQR 7.1-22.9), 20.9% of the 381 patients with morbidity data available had an incident of CVD event. Age < 2 years at start of RRT, receiving dialysis rather than a kidney transplant and primary renal disease (PRD) other than CAKUT or glomerulonephritis (GN), were associated with a higher risk of all-cause mortality. Male sex, receiving dialysis rather than a kidney transplant and PRD other than CAKUT or GN, was associated with a higher risk of CVD incidence. Conclusions Mortality and CVD incidence among children receiving RRT are high. PRD and RRT modality were associated with increased risk of both all-cause mortality and CVD incidence.

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Section: Conclusion and Clinical Implicationsmentioning

confidence: 96%

Long-term all-cause mortality and cardiovascular outcomes in Scottish children after initiation of renal replacement therapy: a national cohort study

et al. 2019

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“…HTN is a frequent cause of complications in paediatric patients after kidney transplantation and represents a significant risk factor for cardiovascular diseases. [3][4][5][6] For this reason, transplanted children constitute a critical group and knowledge of new risk factors is of great importance.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The development or persistence of hypertension (HTN) during the post-transplantation period is a major cardiovascular comorbidity among these patients. [3][4][5][6] It is also likely that post-transplantation HTN promotes graft loss and decreases survival due to its adverse effect on renal function. 5 Besides donor and recipient factors, the most commonly identified risk factors for post-transplantation HTN include time on dialysis, immunosuppressive therapy, and transplant renal artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

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Is low birth weight an additional risk factor for hypertension in paediatric patients after kidney transplantation?

Santos

Borges

Souza

et al. 2019

J Dev Orig Health Dis

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Hypertension (HTN) remains a common complication after kidney transplantation among paediatric patients. Although low birth weight (LBW) has been implicated as an important risk factor for cardiovascular diseases, its effect on transplantation patients has not yet been addressed. It is essential to determine whether children with LBW who undergo transplantation are more likely to develop post-transplantation HTN. For this study, the medical records of 96 kidney recipients were retrospectively examined. A total of 83 patients fulfilled the inclusion criteria. Overall, post-transplantation HTN was observed in 54% of the recipients. Multivariate logistic regression revealed that time from transplantation >14 months (odds ratio (OR) 3.6; 95% confidence interval (CI) 1.31–10.06; P = 0.013), current CKD (OR 2.6; 95% CI 1.01–7.20; P = 0.045), presence of LBW (OR 3.6; 95% CI 1.04–12.32; P = 0.044) and current overweight/obesity (OR 3.7; 95% CI 1.02–13.91; P = 0.047) were associated with post-transplantation HTN. In conclusion, our data provide evidence for the first time that LBW is a significant predictive factor in the development of post-transplantation HTN. This finding has important clinical implications as it serves to alert clinicians about this additional risk factor in paediatric patients undergoing kidney transplant.

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“…This has been reflected by the publication of international guidelines for the optimal diagnosis and management of hypertension in children and by a growing number of review articles on the topic of childhood hypertension post-renal transplantation [10–19]. …”

Section: Introductionmentioning

confidence: 99%

Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation

Krmar

Ferraris

2017

Pediatr Nephrol

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Hypertension is a highly prevalent co-morbidity in pediatric kidney transplant recipients. Undertreated hypertension is associated with cardiovascular complications and negatively impacts renal graft survival. Thus, the accurate measurement of blood pressure is of the utmost importance for the correct diagnosis and subsequent management of post-renal transplant hypertension. Data derived from the general population, and to a lesser extent from the pediatric population, indicates that ambulatory blood pressure monitoring (ABPM) is superior to blood pressure measurements taken in the clinical setting for the evaluation of true mean blood pressure, identification of patients requiring antihypertensive treatment, and in the prediction of cardiovascular outcome. This Educational Review will discuss the clinical value of ABPM in the identification of individual blood pressure phenotypes, i.e., normotension, new-onset hypertension, white-coat hypertension, masked hypertension, controlled blood pressure, and undertreated/uncontrolled hypertension in pediatric kidney transplant recipients. Finally, we examine the utility of performing repeated ABPM for treatment monitoring of post-renal transplant hypertension and on surrogate markers related to relevant clinical cardiovascular outcomes. Taken together, our review highlights the clinical value of the routine use of ABPM as a tool for identifying and monitoring hypertension in pediatric kidney transplant recipients.

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Hypertension in the Pediatric Kidney Transplant Recipient

Cited by 17 publications

References 109 publications

Long-term all-cause mortality and cardiovascular outcomes in Scottish children after initiation of renal replacement therapy: a national cohort study

Long-term all-cause mortality and cardiovascular outcomes in Scottish children after initiation of renal replacement therapy: a national cohort study

Is low birth weight an additional risk factor for hypertension in paediatric patients after kidney transplantation?

Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation

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