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Achieved clinic blood pressure level and chronic kidney disease progression in children: a report from the Chronic Kidney Disease in Children cohort

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Abstract

Background

Control of hypertension delays progression of pediatric chronic kidney disease (CKD), yet few data are available regarding what clinic blood pressure (BP) levels may slow progression.

Methods

Longitudinal BP data from children in the Chronic Kidney Disease in Children cohort study who had hypertension or an auscultatory BP ≥ 90th percentile were studied. BP categories were defined as the maximum systolic or diastolic BP percentile (< 50th, 50th to 75th, 75th to 90th, and ≥ 90th percentile) with time-updated classifications corresponding to annual study visits. The primary outcome was time to kidney replacement therapy or a 30% decline in estimated glomerular filtration rate. Cox proportional hazard models described the effect of each BP category compared to BP ≥ 90th percentile.

Results

Seven hundred fifty-four participants (median age 9.9 years at study entry) met inclusion criteria; 65% were male and 26% had glomerular CKD. Any BP < 90th percentile was associated with a decreased risk of progression for those with glomerular CKD (hazard ratio (HR), 0.63; 95% CI, 0.28–1.39 (< 50th); HR, 0.59; 95% CI, 0.28–1.26 (50th–75th); HR, 0.40; 95% CI, 0.18–0.93 (75th–90th)). Similar results were found for those with non-glomerular CKD: any BP < 90th percentile was associated with decreased risk of progression (HR, 0.78; 90% CI, 0.49–1.25 (< 50th); HR, 0.53; 95% CI, 0.33–0.84 (50th–75th); HR, 0.71; 95% CI, 0.46–1.08 (75th–90th)).

Conclusions

Achieved clinic BP < 90th percentile was associated with slower CKD progression in children with glomerular or non-glomerular CKD. These data provide guidance for management of children with CKD in the office setting.

Graphical abstract

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Data availability

Data that support the findings of this study are available from the corresponding author on reasonable request. The CKiD cohort study additionally provides comprehensive publicly available data through the National Institute of Diabetes and Digestive and Kidney Diseases Central Repository (https://www.niddkrepository.org/home/).

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Acknowledgments

Data in this manuscript were collected by the Chronic Kidney Disease in Children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri - Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek K. Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD website is located at https://statepi.jhsph.edu/ckid.

The authors thank Michelle C. Starr, MD, MPH for her help with creation of the visual abstract.

Funding

The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01 DK066143, U01 DK066174, U24 DK082194, U24 DK066116).

Author information

Authors and Affiliations

  1. Division of Nephrology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Joseph T. Flynn

  2. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Joseph T. Flynn

  3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Megan K. Carroll & Derek K. Ng

  4. Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan L. Furth

  5. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Susan L. Furth

  6. Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

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  1. Joseph T. Flynn
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  2. Megan K. Carroll
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  3. Derek K. Ng
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  4. Susan L. Furth
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  5. Bradley A. Warady
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Corresponding author

Correspondence to Joseph T. Flynn.

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Conflict of interest

Joseph Flynn reports grants from the American Heart Association, personal fees from Silvergate Phamaceuticals, Ultragenyx, Springer, and Up To Date outside the published work. All other authors declare that they have no conflict of interest.

Ethical approval

The CKiD protocol has been approved by the Institutional Review Boards/Ethics Committees of the participating centers. All participants/their parents provided written informed consent/assent according to local requirements.

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Flynn, J.T., Carroll, M.K., Ng, D.K. et al. Achieved clinic blood pressure level and chronic kidney disease progression in children: a report from the Chronic Kidney Disease in Children cohort. Pediatr Nephrol 36, 1551–1559 (2021). https://doi.org/10.1007/s00467-020-04833-8

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  • DOI: https://doi.org/10.1007/s00467-020-04833-8

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