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Single-channel Analysis and Calcium Imaging in the Podocytes of the Freshly Isolated Glomeruli
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L-type calcium channel blocker use and proteinuria among children with chronic kidney diseases

Kelsey L Richardson1, Donald J Weaver2, Derek K Ng3

  • 1Division of Pediatric Nephrology, Oregon Health & Sciences University, Portland, OR, USA.

Pediatric Nephrology (Berlin, Germany)
|February 16, 2021
PubMed

Insights

Dihydropyridine calcium channel blockers (dhCCBs) increase proteinuria in children with chronic kidney disease (CKD). These medications do not improve blood pressure control in pediatric CKD patients.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Pharmacology

Background:

  • Hypertension is a prevalent comorbidity in pediatric chronic kidney disease (CKD).
  • Dihydropyridine calcium channel blockers (dhCCBs) are commonly prescribed for hypertension in children with CKD.
  • The specific effects of dhCCBs on proteinuria in this population remain incompletely understood.

Purpose of the Study:

  • To investigate the association between dhCCB use and proteinuria in children with CKD.
  • To evaluate the impact of dhCCBs on blood pressure control in pediatric CKD patients.
  • To examine the role of concomitant Angiotensin-converting enzyme inhibitor (ACEi) and Angiotensin receptor blocker (ARB) therapy as a modifier of dhCCB effects on proteinuria.

Main Methods:

  • Analysis of data from 722 participants in the Chronic Kidney Disease in Children (CKiD) cohort.
  • Assessment of the association between dhCCB use and log-transformed urine protein/creatinine ratio.
  • Evaluation of blood pressure control and the modifying effect of ACEi/ARB use on dhCCB-associated proteinuria.

Main Results:

  • dhCCB use was linked to an 18.8% increase in urine protein/creatinine levels compared to no dhCCB or ACEi/ARB use.
  • In children concurrently treated with ACEi and ARB, dhCCB use did not significantly increase proteinuria.
  • Children on dhCCBs exhibited higher systolic and diastolic blood pressures.

Conclusions:

  • dhCCB therapy in children with CKD and hypertension is associated with elevated proteinuria.
  • dhCCB use did not demonstrate a benefit in improving blood pressure control in this cohort.
  • Concomitant ACEi/ARB therapy may mitigate the adverse effect of dhCCBs on proteinuria.
Abstract

Keywords:
Calcium channel blockerChildrenChronic kidney diseaseHypertensionProteinuria

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