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Kidney Week

Abstract: TH-OR050

Prevalence of Blood Pressure Control in Children with Kidney Transplant

Session Information

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Winterberg, Pamela D., Emory University School of Medicine, Atlanta, Georgia, United States
  • Garro, Rouba, Emory University School of Medicine, Atlanta, Georgia, United States
  • Dahale, Devesh S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goebel, Jens W., Children's Hospital Colorado, Aurora, Colorado, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Group or Team Name

  • Improving Renal Outcomes Collaborative
Background

Hypertension (HTN) is common in children following kidney transplant (KT) with reported prevalence of 60-90%. Uncontrolled blood pressure (BP) is associated with cardiovascular mortality and decreased graft survival. The Improving Renal Outcomes Collaborative (IROC) is a networked learning health system of 23 pediatric centers dedicated to improving health outcomes and longevity for children with kidney disease by sharing best practices and clinical data, and engaging in quality improvement (QI). We aimed to determine the baseline prevalence of systolic BP control and treatment within the collaborative after implementing standardized processes for BP measurement across centers.

Methods

Patient and KT characteristics were uploaded into the IROC registry via UNOS TEIDI reports. Biometric data, BP measurements, and medications are prospectively entered by centers for each clinic visit. BP percentiles are automatically calculated in the registry using the 2004 NHBPEP 4th Report to determine BP status for each visit (e.g. normal, pre-HTN, stage 1, stage 2). We examined the latest clinic visit for each patient >90 days post-transplant in the registry. Patients were classified by systolic BP control (<90th percentile) and treatment status.

Results

Of the 935 unique patients with at least 1 visit in the registry, 56% had uncontrolled systolic BP (pre-HTN or greater) and/or were on BP medications. Of the 492 pts receiving BP meds, 132 (27%) had uncontrolled systolic BP at last visit. In addition, 31 patients (3% of total) had uncontrolled systolic BP at last visit but no record of BP medication. Of those treated, 80% had one, 16% had 2, and 8% had 3 or more active BP meds. Calcium channel blockers (80%) were most commonly used for treatment of BP followed by renin-angiotensin system blockade (33%), and beta-adrenergic blockade (23%).

Conclusion

HTN is common in pediatric KT patients in the IROC registry. Nearly one-quarter of those treated for HTN have not achieved systolic BP control. Future studies within IROC will evaluate patient- and center-level factors influencing BP control.

Patients categorized by BP control and treatment status.