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Hypertension in Pediatric Long-term Hemodialysis Patients in the United States

Blanche M. Chavers^*,,, Craig A. Solid, Frank X. Daniels, Shu-Cheng Chen, Allan J. Collins^,, Diane L. Frankenfield^||, and Charles A. Herzog^,

^* Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; United States Renal Data System, Minneapolis, Minnesota; Cardiovascular Special Studies Center, United States Renal Data System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; ^|| Office of Research, Development, and Information, Centers for Medicare & Medicaid Services, Baltimore, Maryland

Correspondence: Dr. Blanche M. Chavers, University of Minnesota, Department of Pediatrics, Mayo Mail Code 491, 420 Delaware Street SE, Minneapolis, MN 55455. Phone: 612-626-2922; Fax: 612-626-2791; E-mail: chave001{at}umn.edu

Background and objectives: Data are limited regarding BP distribution and the prevalence of hypertension in pediatric long-term dialysis patients. This study aimed to examine BP distribution in U.S. pediatric long-term hemodialysis patients.

Design, setting, participants, & measurements: This cross-sectional study of all U.S. pediatric (aged 0-< 18 yr, n = 624) long-term hemodialysis patients was performed as part of the Centers for Medicare & Medicaid Services End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. BP and clinical information were collected monthly in October, November, and December 2001. Hypertension was defined as the mean of pre- and postdialysis systolic or diastolic BP above the 95th percentile for age, height, and sex, or antihypertensive medication use. Results were calculated by age, sex, race, ethnicity, ESRD duration, body mass index percentile, primary cause of ESRD, and laboratory data.

Results: Hypertension was present in 79% of patients; 62% used antihypertensive medication. Five percent of patients were prehypertensive (mean BP at 90th to 95th percentile). Hypertension was uncontrolled in 74% of treated patients. Characteristics associated with hypertension included acquired kidney disease, shorter duration of ESRD, and lower mean hemoglobin and calcium values. Characteristics associated with uncontrolled hypertension were younger age and shorter duration of ESRD.

Conclusions: Hypertension is common in U.S. pediatric long-term hemodialysis patients, uncontrolled in 74% of treated patients, and untreated in 21% of hypertensive patients. It is concluded that a more aggressive approach to treatment of hypertension is warranted in pediatric long-term hemodialysis patients.