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Pediatr Nephrol. 2020 Mar;35(3):415-426. doi: 10.1007/s00467-019-04395-4. Epub 2019 Dec 7.

Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry.

Author information

1
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
2
Department of Nephrology, Hannover Medical School, Hannover, Germany.
3
Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
4
Department of Pediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
5
Department of General Pediatrics, University Hospital Muenster, Muenster, Germany.
6
Renal Transplant Clinic, Bambino Gesu Children's Hospital IRCCS, Rome, Italy.
7
Pediatric Nephrology, Dialysis and Transplant Unit, Hospital University Padua, Padua, Italy.
8
Division of Pediatric Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey.
9
Olga Children's Hospital, Clinic of Stuttgart, Stuttgart, Germany.
10
Royal Manchester Hospital, Manchester, UK.
11
Center for Children and Adolescent, Pediatric Clinic II, University of Duisburg-Essen, Essen, Germany.
12
KfH Kidney Centre for Children and Adolescents, St. Georg Hospital, Leipzig, Germany.
13
Department of General Pediatrics, University of Tuebingen, Tuebingen, Germany.
14
Division of Pediatric Nephrology and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
15
University Children's Hospital Rostock, Rostock, Germany.
16
Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
17
Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
18
KfH Kidney Centre for Children and Adolescents, University Hospital Giessen-Marburg, Marburg, Germany.
19
Department of Pediatric Nephrology, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey.
20
The Children's Memorial Health Institute, Warsaw, Poland.
21
Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany.
22
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Melk.Anette@mh-hannover.de.

Abstract

BACKGROUND:

High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated.

METHODS:

This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant.

RESULTS:

At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP z-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP z-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected.

CONCLUSIONS:

BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls).

KEYWORDS:

Children; Cyclosporine; Hypertension; Immunosuppression; Kidney transplantation; Sex differences

PMID:
31811541
DOI:
10.1007/s00467-019-04395-4

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