Hypertension and Progression of Chronic Renal Insufficiency in Children

Abstract

Hypertension frequently complicates the course of chronic renal insufficiency (CRI) in children. This study sought to define the role of hypertension in progression of CRI in children by using the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) CRI database. The study cohort consisted of 3834 patients aged 2 to 17 yr with an estimated GFR (eGFR) </=75 ml/min.1.73 m2 enrolled onto NAPRTCS. The time to end point was defined as the time between registry enrollment and progression to renal substitution therapy or a 10 ml/min.1.73 m2 drop in GFR from baseline, whichever was first. Forty-eight percent of the study patients had hypertension at baseline. There was a significant difference in reaching end points between hypertensive and normotensive children (58% versus 49%, respectively, P < 0.001). Significant difference in outcome between hypertensive and nonhypertensive patients was seen in children with eGFR 50 to 75 ml/min.1.73 m2 (P < 0.001). Multivariate Cox regression modeling demonstrated that systolic hypertension was a significant independent predictor of progression of CRI (P = 0.003). Other significant predictors of CRI progression in this model included older age (P = 0.0001), African American ethnicity (P = 0.03), acquired cause of renal disease (P = 0.0001), and baseline eGFR <50 ml/min.1.73 m2 (P = 0.0001). Hypertension is a highly significant and independent predictor for progression of CRI in children.