Kidney Week

Abstract: TH-PO472

Hypertension and Dyslipidemia in Childhood Nephrotic Syndrome

Session Information

• Hypertension and CVD: Epidemiology, Risk Factors, Prevention
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

• Thomas, Elizabeth, Cohen Children Medical Center, Glen Oaks, New York, United States

Elizabeth Thomas,

• Meyers, Kevin E.C., The Children Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, United States

Kevin E.C. Meyers,

• Brady, Tammy M., Johns Hopkins University, Baltimore, Maryland, United States

Tammy M. Brady,

• Gipson, Debbie S., University of Michigan Mott Children's Hospital, Ann Arbor, Michigan, United States

Debbie S. Gipson,

• Kaskel, Frederick J., Children’s Hospital at Montefiore, Bronx, New York, United States

Frederick J. Kaskel,

• Srivastava, Tarak, Childrens's Mercy Hospital, Kansas City, Missouri, United States

Tarak Srivastava,

• Gibson, Keisha L., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States

Keisha L. Gibson,

• Tran, Cheryl L., Mayo Clinic, Rochester, Minnesota, United States

Cheryl L. Tran,

• Reidy, Kimberly J., Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States

Kimberly J. Reidy,

• Levy, Rebecca, Montefiore Medical Center, New York, New York, United States

Rebecca Levy,

• Sethna, Christine B., Cohen Children's Medical Center of NY, New Hyde Park, New York, United States

Christine B. Sethna,

Group or Team Name

• NEPTUNE Pediatric Working Group

Background

Children with nephrotic syndrome (NS) often have hypertension (HTN) and dyslipidemia (DLP). However, these CVD risk factors have not been well described over time and in relation to renal outcomes in NS.

Methods

Longitudinal analysis of children with new onset NS in the Nephrotic Syndrome Study Network (NEPTUNE) was conducted. HTN and DLP were defined as per established definitions (Flynn 2017, Daniels 2011). BP was indexed (BPi) to the 95%. Generalized Estimating Equation models compared HTN and DLP among those reaching complete remission (CR) (urine protein:creatinine [UPC] <0.3) vs. no CR. Regression models examined the association of baseline BP and lipids with outcomes of CR, 40% eGFR drop, eGFR <90 ml/min/1.73m² at last follow up and eGFR slope adjusted for age, sex, race, follow up, medications, eGFR and obesity.

Results

81 children (4.3±2.3 yr, 63% M, 24% black) with mean baseline eGFR 112±48 ml/min/1.73m² and UPC 4.5±9.2 were evaluated. At baseline, 58% had HTN and 81% had DLP (Table). Among CR, DLP decreased over time (Q10.8, p=0.01) but HTN did not change (Q10.8, p=0.39). For no CR, HTN and DLP did not change over time. In adjusted models, no CR had greater odds of HTN (OR 3.4 CI1.16-10.8) and greater LDL (β 35 CI 2.9,68) over time. For outcomes, baseline elevated total cholesterol (HR 1.01 CI 1.00-1.01), greater LDL (HR 1.01 CI1.0-1.02) and triglycerides (HR 1.01 CI 1.001-1.01) were associated with increased risk of 40% eGFR drop. Baseline BP and lipids were not associated with other outcomes.

Conclusion

In NEPTUNE, HTN and DLP were prevalent in children with new onset NS and were worse over time in those with no CR. In addition, baseline lipids were found to independently predict poorer renal outcomes.

Funding

• Other NIH Support