Publication Date

Spring 4-29-2019

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Mentor, Preceptor, Principle Investigator

Principle Investigator: Benjamin A Matta, MD Mentor/Preceptor: Darcy Weidemann, MD

Abstract

Background

Hypertension (HTN) is a highly prevalent and major risk factor for poor cardiovascular and renal outcomes in chronic kidney disease (CKD). Previous research suggests that HTN is underdiagnosed and undertreated in children with CKD. To our knowledge no studies have investigated the effect of antihypertensive (antiHTN) dose on blood pressure (BP) control in this population.

Objective

To determine the effect of antiHTN dose on HTN status in children with CKD.

Methods

Study population: 255 participants studied in the Chronic Kidney Disease in Children (CKiD) study at their 3rd visit, taking at least 1 antiHTN drug.

Cumulative Drug Dose Index (cDDI): We developed a new quantitative tool, Drug Dose Index (DDI) which is expressed as a ratio between the current dose and the maximum potential dose, accounting for age, weight and renal dose adjustments. cDDI = sum DDI for all antiHTN agents for a subject.

Primary outcome: HTN status - controlled HTN (cHTN) or uHTN (= masked HTN or ambulatory HTN).

Secondary outcome: Left ventricular hypertrophy.

Statistical analysis: Univariate analysis: Comparison of cDDI between the outcome groups. Multivariate Logistic Regression: 2 models with outcomes: uHTN and LVH.

Results/Discussion

This was the 1st quantitative analysis of antiHTN dose (cDDI), and its relationship with HTN status in children with CKD. No differences in cDDI between uHTN vs. cHTN, or LVH vs. no LVH, but higher cDDI was associated with AH on univariate analysis. RAASi and diuretic use were associated with lower odds of uHTN. Non-Caucasian race, absence of RAASi and diuretic agents, and higher number of agents were associated with uHTN. Female gender, higher BMI z-score, lower eGFR, higher number of agents and lower cDDI were associated with LVH. Further research is needed to validate the use of cDDI and the the roles of medication class and dose on BP control in children with CKD.

MeSH Keywords

Hypertension; Hypertrophy, Left Ventricular; Renal Insufficiency, Chronic; Dose-Response Relationship, Drug

Keywords

Cumulative Drug Dose Index; Hypertension; Left Ventricular Hypertrophy; Chronic Kidney Disease; CKiD study

Disciplines

Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Medical Pharmacology | Nephrology | Pediatrics

Notes

Acknowledgement: Dr. Vincent Staggs, statistical counselling

The Effect of Antihypertensive Dosing on Hypertension in Children with Chronic Kidney Disease

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