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Hypertension in children with chronic kidney disease: pathophysiology and management

Charlotte Hadtstein1, Franz Schaefer

  • 1Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital of Heidelberg, Im Neuenheimer Feld 151, 69120, Heidelberg, Germany.

Pediatric Nephrology (Berlin, Germany)
|November 9, 2007
PubMed

Insights

Children with chronic kidney disease (CKD) frequently develop arterial hypertension. Early screening and management, including non-pharmacological and pharmacological approaches, are crucial for better renal and cardiovascular outcomes in pediatric CKD patients.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Health in Chronic Kidney Disease

Background:

  • Arterial hypertension is highly prevalent across all stages of chronic kidney disease (CKD) in children.
  • Established factors include fluid overload and renin-angiotensin system activation, with recent evidence highlighting sympathetic hyperactivation, endothelial dysfunction, and hyperparathyroidism.
  • Medications commonly used in CKD (e.g., erythropoietin, glucocorticoids, cyclosporine A) can independently elevate blood pressure.

Purpose of the Study:

  • To emphasize the critical need for active screening of hypertension in all pediatric CKD patients.
  • To outline management strategies, prioritizing non-pharmacological interventions before initiating antihypertensive drug therapy.
  • To underscore the importance of achieving blood pressure targets for improved renal and cardiovascular outcomes.

Main Methods:

  • Review of pathophysiological mechanisms contributing to CKD-associated hypertension in children.
  • Discussion of non-pharmacological interventions, including dietary modifications and dialysis adjustments (low salt, low dialysate sodium, optimized dry weight).
  • Evaluation of first-line antihypertensive pharmacotherapies (ACE inhibitors, ARBs for proteinuria) and adjunctive therapies (diuretics).

Main Results:

  • Non-pharmacological strategies, particularly in hemodialysis patients, can significantly aid blood pressure control.
  • ACE inhibitors and ARBs are recommended for patients with proteinuria due to their dual benefits.
  • Multiple antihypertensive medications are frequently necessary to achieve target blood pressure levels (below the 90th percentile).

Conclusions:

  • Proactive hypertension screening and management are essential in pediatric CKD.
  • A combination of lifestyle modifications and pharmacotherapy is often required for effective blood pressure control.
  • Optimal blood pressure management is vital for mitigating CKD progression and reducing long-term cardiovascular risk.

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