Kidney Week

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

Reeti Kumar,

• Reed, Suzanne, Nationwide Children''s Hospital, Columbus, Ohio, United States

Suzanne Reed,

• Mahan, John D., Nationwide Children's Hospital, Columbus, Ohio, United States

John D. Mahan,

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) ≥ 95^th %tile for age/height at diagnosis & 1 month post diagnosis. Chronic HTN was defined as 2 consecutive SBP &/or DBP readings ≥ 95^th %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 1^st month of diagnosis developed chronic HTN. There was an overall trend in increased HTN indices (subject’s BP/subject-specific 95^th %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.