Abstract: FR-OR52
Long-Term Kidney Outcomes in Children and Adolescents with Hypertension
Session Information
- Hypertension, CVD, and the Kidneys: Clinical Studies
October 25, 2024 | Location: Room 5, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada
- Hussain, Junayd, McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
- Brady, Tammy McLoughlin, Johns Hopkins Children's Center, Baltimore, Maryland, United States
- Dionne, Janis M., BC Children's Hospital, Vancouver, British Columbia, Canada
- Karam, Sabine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- McKay, Ashlene Maree, The Hospital for Sick Children, Toronto, Ontario, Canada
- Shroff, Rukshana, University College London Faculty of Medical Sciences, London, United Kingdom
- Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
Background
Hypertension affects 6% of all children and its prevalence is increasing. Pediatric hypertension has been associated with elevated risks of all-cause mortality and cardiovascular events among children and adults. In children with chronic kidney disease, hypertension is associated with progression to kidney failure. However, in those with no prior kidney diseasedirect evidence linking pediatric hypertension, with long-term kidney outcomes is limited. We aim to determine the long-term risks of developing chronic kidney disease and kidney failure among children with hypertension.
Methods
Population-based retrospective cohort study of all children (ages 3-18 years) diagnosed with hypertension from 1996 to 2021 in Ontario, Canada, using validated case definitions in health administrative databases. Each case was propensity score-matched with five normotensive controls by age, sex, birthweight, maternal gestational hypertension, prior diabetes mellitus, cardiovascular surgery, and a propensity score for hypertension diagnosis. Primary outcomes were incident stage 3 chronic kidney disease and end-stage kidney disease (initiation of chronic dialysis, or receipt of kidney transplant).
Results
A total of 25,605 children and adolescents with hypertension were matched to 128,025 controls without hypertension. Children were followed until death(0.7%), emigration from Ontario(11.2%), or study end(88.1%). Median age was 15 years[IQR 11-17], 49% were female, and prior comorbidities were uncommon(1% had congenital heart disease, 1.7% malignancy, 0.4% diabetes). During a median of 12.9 years[IQR 6.8-19.9) of follow up, the incidence rate(IR) of chronic kidney disease was 4.84/1000 person-years(py) in children with hypertension vs 0.42/1000py in controls (adjusted hazard ratio(aHR) 5.9, 95% CI 5.5-6.4). Children with hypertension were also at increased risk of end-stage kidney disease (IR 1.11 vs 0.03/1000py; aHR 9.6, 95% CI 7.8-11.9) compared to controls.
Conclusion
Children and adolescents diagnosed with hypertension are at higher long-term risks of chronic kidney disease and kidney failure, compared to non-hypertensive controls. Improved pediatric hypertension recognition and control may prevent progressive kidney function decline. These findings should be confirmed by large-scale, well controlled prospective studies.