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Antihypertensive medication nonadherence and target organ damage in children with chronic kidney disease
Rushelle L Byfield1,2, Rui Xiao3, Daichi Shimbo4
1Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17-102E, NY, 10032, New York, USA. rb2777@cumc.columbia.edu.
Insights
Antihypertensive medication nonadherence in children with chronic kidney disease (CKD) was observed in 14% of participants. This study found no significant associations between nonadherence and kidney function or cardiac structure over time.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Chronic Disease
- Medication Adherence Research
Background:
- Nonadherence to antihypertensive medications is prevalent in pediatric chronic kidney disease (CKD).
- This nonadherence may negatively impact blood pressure control and long-term health outcomes in children with CKD.
- Understanding these associations is crucial for improving management strategies.
Purpose of the Study:
- To investigate the relationship between antihypertensive medication nonadherence and ambulatory blood pressure monitoring (ABPM) parameters in children with CKD.
- To examine the associations of nonadherence with kidney function indicators, specifically estimated glomerular filtration rate (eGFR) and urine protein to creatinine ratio (UPCR).
- To assess the impact of nonadherence on cardiac structure, measured by left ventricular mass index (LVMI).
Main Methods:
- Secondary analysis of data from the CKD in Children (CKiD) cohort.
- Inclusion of participants with treated hypertension who underwent regular ABPM, laboratory tests, and echocardiography.
- Definition of nonadherence based on self-report of missed antihypertensive medications within 7 days prior to study visits; statistical analysis using linear regression and mixed-effects models.
Main Results:
- The study included 508 children with CKD, with 14% reporting nonadherence to antihypertensive medications.
- No significant associations were found between baseline nonadherence and baseline ABPM parameters, eGFR, UPCR, or LVMI.
- Similarly, no significant associations were observed between baseline nonadherence and time-updated measures of these outcomes.
Conclusions:
- Self-reported nonadherence to antihypertensive medications affects approximately 1 in 7 children with CKD.
- The study found no evidence linking medication nonadherence to changes in kidney function or cardiac structure over the follow-up period.
- Further research may be needed to explore other factors influencing outcomes in this population.
Background:
Nonadherence is common in children with chronic kidney disease (CKD). This may contribute to inadequate blood pressure control and adverse outcomes. This study examined associations between antihypertensive medication nonadherence, ambulatory blood pressure monitoring (ABPM) parameters, kidney function, and cardiac structure among children with CKD.
Methods:
We performed secondary analyses of data from the CKD in Children (CKiD) study, including participants with treated hypertension who underwent ABPM, laboratory testing, and echocardiography biannually. Nonadherence was defined by self-report of any missed antihypertensive medication 7 days prior to the study visit. Linear regression and mixed-effects models were used to assess the association of nonadherence with baseline and time-updated ABPM profiles, estimated glomerular filtration rate (eGFR), urine protein to creatinine ratio (UPCR), and left ventricular mass index (LVMI).
Results:
Five-hundred and eight participants met inclusion criteria, followed for a median of 2.9 years; 212 (42%) were female, with median age 13 years (IQR 10-16), median baseline eGFR 49 (33-64) ml/min/1.73 m2 and median UPCR 0.4 (0.1-1.0) g/g. Nonadherence occurred in 71 (14%) participants. Baseline nonadherence was not significantly associated with baseline 24-h ABPM parameters (for example, mean 24-h SBP [β - 0.1, 95% CI - 2.7, 2.5]), eGFR (β 1.0, 95% CI - 0.9, 1.2), UCPR (β 1.1, 95% CI - 0.8, 1.5), or LVMI (β 0.6, 95% CI - 1.6, 2.9). Similarly, there were no associations between baseline nonadherence and time-updated outcome measures.
Conclusions:
Self-reported antihypertensive medication nonadherence occurred in 1 in 7 children with CKD. We found no associations between nonadherence and kidney function or cardiac structure over time. A higher resolution version of the Graphical abstract is available as Supplementary information.
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