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Abstract: FR-PO1139

Hypertension in Children with Acute Lymphoblastic Leukemia in the Modern Era

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Kumar, Reeti, Nationwide Children''s Hospital, Columbus, Ohio, United States
  • Reed, Suzanne, Nationwide Children''s Hospital, Columbus, Ohio, United States
  • Mahan, John D., Nationwide Children's Hospital, Columbus, Ohio, United States
Background

In recent decades, the prognosis of acute lymphoblastic leukemia (ALL) has improved with innovations in chemotherapy, bone marrow transplantation (BMT), & better supportive therapy. Given these better outcomes, understanding & managing complications associated with ALL have become more important. Hypertension (HTN) is a known complication of ALL & has been attributed to multiple factors, including renal leukemic infiltration, AKI, & high dose steroids. There is a paucity of data on the incidence of HTN in children diagnosed with ALL in the recent decades. Prior studies have shown wide variation in incidence of HTN ranging from 6.3-52.9% in children with ALL. The aim of this study is to define the incidence of acute & chronic HTN in pediatric patients diagnosed with ALL in more recent years.

Methods

This study is a retrospective chart review of pediatric patients diagnosed with ALL at Nationwide Children’s Hospital between 1/1/2008 & 12/31/2016. BP data was collected from diagnosis to 9 yrs post-diagnosis or until a following end point: lost to follow-up, received BMT, or deceased. BP values obtained in the lower extremity or while the patient was agitated were excluded. Acute HTN was defined as systolic blood pressure (SBP) &/or diastolic blood pressure (DBP) ≥ 95th %tile for age/height at diagnosis & 1 month post diagnosis. Chronic HTN was defined as 2 consecutive SBP &/or DBP readings ≥ 95th %tile for age/height 6 months or more after ALL diagnosis.

Results

222 patients were reviewed. The incidence of acute HTN was 35% & chronic HTN 34%. 52% of pts who had acute HTN developed chronic HTN, whereas 24% of pts who were normotensive in 1st month of diagnosis developed chronic HTN. There was an overall trend in increased HTN indices (subject’s BP/subject-specific 95th %tile) from diagnosis to 1 month post diagnosis. Median HTN indices for SBP increased from 0.98 to 1.04 & for DBP increased from 0.91 to 1.00. A large percentage of hypertensive patients did not receive anti-HTN therapy - 55% with acute HTN & 76% with chronic HTN were untreated.

Conclusion

Among children with ALL, there is a high incidence of HTN at time of diagnosis & in long-term follow-up. There is an overall trend for higher blood pressures after initiation of induction chemotherapy. In children with ALL, HTN often goes undiagnosed & untreated & yet is likely to convey long term sequelae.