Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry.
Adolescent
Age Factors
Blood Pressure Determination
/ statistics & numerical data
Child
Child, Preschool
Cyclosporine
/ administration & dosage
Europe
/ epidemiology
Female
Follow-Up Studies
Graft Rejection
/ immunology
Humans
Hypertension
/ diagnosis
Immunosuppressive Agents
/ administration & dosage
Kidney Transplantation
/ adverse effects
Longitudinal Studies
Male
Prevalence
Registries
/ statistics & numerical data
Retrospective Studies
Sex Factors
Tacrolimus
/ administration & dosage
Time Factors
Transplant Recipients
/ statistics & numerical data
Children
Cyclosporine
Hypertension
Immunosuppression
Kidney transplantation
Sex differences
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
29
05
2019
accepted:
07
10
2019
revised:
25
07
2019
pubmed:
8
12
2019
medline:
2
2
2021
entrez:
8
12
2019
Statut:
ppublish
Résumé
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. 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. 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. 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).
Sections du résumé
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).
Identifiants
pubmed: 31811541
doi: 10.1007/s00467-019-04395-4
pii: 10.1007/s00467-019-04395-4
doi:
Substances chimiques
Immunosuppressive Agents
0
Cyclosporine
83HN0GTJ6D
Tacrolimus
WM0HAQ4WNM
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
415-426Références
J Hypertens. 2002 Oct;20(10):1995-2007
pubmed: 12359978
J Clin Endocrinol Metab. 2016 Jul;101(7):2667-74
pubmed: 27014950
Curr Hypertens Rep. 2012 Dec;14(6):608-18
pubmed: 23011742
Adv Ther. 2017 Jun;34(6):1349-1363
pubmed: 28432647
Transplant Proc. 2012 Nov;44(9):2579-81
pubmed: 23146460
Pediatr Transplant. 2006 May;10(3):316-22
pubmed: 16677355
Pediatr Nephrol. 2001 Nov;16(11):843-7
pubmed: 11685585
Nephrol Dial Transplant. 2004 Jun;19 Suppl 3:iii62-6
pubmed: 15192139
J Pediatr. 2014 Jan;164(1):173-177.e7
pubmed: 24120124
Nephrol Dial Transplant. 2012 Aug;27(8):3359-68
pubmed: 22328733
Pediatr Nephrol. 2017 Jun;32(6):949-964
pubmed: 27464647
Pediatrics. 2011 Apr;127(4):e978-88
pubmed: 21382947
Pediatr Nephrol. 2017 Nov;32(11):2143-2154
pubmed: 28804814
Nephrol Dial Transplant. 2017 Feb 1;32(2):402
pubmed: 28186547
J Am Soc Nephrol. 1992 Jun;2(12 Suppl):S243-5
pubmed: 1498282
Kidney Int Suppl. 2002 Dec;(82):S81-7
pubmed: 12410861
J Pediatr. 2000 Apr;136(4):520-3
pubmed: 10753251
Pharmacol Res. 2007 Feb;55(2):81-95
pubmed: 17129734
Lancet. 2002 Mar 2;359(9308):741-6
pubmed: 11888584
JAMA. 2007 Aug 22;298(8):874-9
pubmed: 17712071
J Am Soc Nephrol. 1999 Jun;10(6):1324-30
pubmed: 10361872
Transplantation. 2018 Mar;102(3):484-492
pubmed: 28926375
Am J Kidney Dis. 2004 Jun;43(6):1071-81
pubmed: 15168388
Nephrol Dial Transplant. 2010 Feb;25(2):617-24
pubmed: 19793929
Pediatr Transplant. 2007 Dec;11(8):860-7
pubmed: 17976120
Am J Transplant. 2005 Nov;5(11):2725-31
pubmed: 16212633
J Pediatr. 2003 Jul;143(1):98-103
pubmed: 12915832
Hypertension. 2017 Jul;70(1):66-74
pubmed: 28533330
JAMA. 2000 Feb 2;283(5):633-8
pubmed: 10665703
Transplantation. 2019 Apr;103(4):798-806
pubmed: 29994983
Am J Hypertens. 2016 Jul;29(7):860-5
pubmed: 26657420
Am J Transplant. 2007 Jan;7(1):108-16
pubmed: 17109727
Pediatrics. 2010 Jun;125(6):e1286-93
pubmed: 20439598
J Hypertens. 2016 Oct;34(10):1887-920
pubmed: 27467768
N Engl J Med. 2009 Oct 22;361(17):1639-50
pubmed: 19846849
J Am Soc Nephrol. 2014 Jul;25(7):1554-62
pubmed: 24627349
Pediatr Transplant. 2009 Dec;13(8):1027-33
pubmed: 19077134
Pediatr Transplant. 2019 Feb;23(1):e13329
pubmed: 30537138
J Am Soc Nephrol. 2009 Mar;20(3):629-37
pubmed: 19158356
Transplant Proc. 2013 May;45(4):1414-7
pubmed: 23726585
Kidney Int. 2011 Nov;80(10):1092-8
pubmed: 21814180
Transplantation. 2019 Jun;103(6):1224-1233
pubmed: 30130322
Pediatr Nephrol. 2013 Oct;28(10):2043-51
pubmed: 23708760