Demographics, longitudinal changes and outcome of high blood pressure in children and adolescents on kidney replacement therapy: 15 years of data from the ESPN/ERA Registry

Background: Hypertension (HTN) is a well-known complication among patients on pediatric kidney replacement therapy (KRT). We aimed to evaluate demographics, longitudinal changes and outcomes of high blood pressure (BP) among children and adolescents on KRT. Methods: Data on BP and antihypertensive (AH) medications reported to the ESPN/ERA Registry on 6071 patients from 28 European countries starting KRT < 20 years of age between 2007 and 2021, were included. Results: Hypertension (HTN), AH medication use, and uncontrolled HTN were reported in 60.7%, 45.0%, and 32.0% of patients, respectively. Prevalence of uncontrolled HTN was 49.7% in HD, 42.3% in PD, and 27.3% in transplanted patients. Younger age, dialysis, and shorter KRT vintage were risk factors for uncontrolled HTN. AH medication use was lower among young patients, females and those on dialysis, and higher with a shorter KRT vintage and non-CAKUT kidney disease. Among AH medication users, 27.9% of transplantation, 48.1% of PD and 58.9% of HD patients showed a systolic BP > 95th percentile. Uncontrolled HTN significantly decreased over time in HD patients (52.3% at dialysis start vs. 42.5% after 5 years; annual percentage change [APC] − 3.5%; 95%CI: − 6.2; -0.7), despite similar AH medication use. After 5 years, transplanted patients showed a significant reduction in both prevalence of uncontrolled HTN (APC − 3.6%; 95%CI: − 5.7; − 1.5) and AH medication use (APC − 1.6%; 95%CI: − 2.6; − 0.6%). No trends were found for PD patients. Uncontrolled HTN was not associated with mortality (aHR 1.02; 95%CI: 0.79–1.33). Conclusions: HTN is highly prevalent in children and adolescents on KRT. Younger children and HD patients should be carefully evaluated for BP status after entering dialysis or shortly after transplantation.