Blood pressure control in pediatric hemodialysis: data from the SCOPE collaborative.

Area of Science:

• Pediatric Nephrology
• Cardiovascular Health in Chronic Kidney Disease
• Quality Improvement in Healthcare

Background:

• The Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative aims to enhance care for children on dialysis.
• Cardiovascular disease is a major cause of illness and death in pediatric patients with end-stage kidney disease.
• Accurate blood pressure (BP) measurement is a key focus area for the SCOPE initiative.

Purpose of the Study:

• To determine the prevalence of high BP and hypertension among pediatric hemodialysis patients.
• To identify risk factors associated with hypertension in this population.
• To assess the control and treatment status of hypertension in children on hemodialysis.

Main Methods:

• Analysis of data from 407 pediatric hemodialysis patients across 25 centers in the SCOPE collaborative.
• Collection of 6962 BP measurements from 3532 evaluation forms.
• Classification of BP based on 2017 American Academy of Pediatrics hypertension guidelines, including assessment of uncontrolled, controlled, untreated, and persistent hypertension.

Main Results:

• Over half (54.3%) of BP measurements were abnormal, with significant proportions classified as Stage I (25.4%) and Stage II (16.3%) hypertension.
• Nearly half (47.7%) of patients exhibited uncontrolled BP, and 13.8% had untreated hypertension.
• A substantial 37.1% of patients had persistent hypertension, with no significant associations found regarding age, renal diagnosis, race, or sex.

Conclusions:

• Uncontrolled and untreated hypertension is highly prevalent in pediatric hemodialysis patients within the SCOPE collaborative, even with regular antihypertensive medication use.
• These findings underscore the challenges in managing BP in this vulnerable population.
• The study's robust methodology, utilizing repeated and standardized post-dialysis measurements, provides reliable insights into hypertension prevalence and control in pediatric end-stage kidney disease.