Kidney Week

Abstract: TH-OR122

Effect of Updated Hypertension Guidelines on Blood Pressure Staging in Pediatric Kidney Transplant Recipients

Session Information

• Pediatric Nephrology Research
  November 07, 2019 | Location: 152, Walter E. Washington Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Pediatric Nephrology

• 1700 Pediatric Nephrology

Authors

• Garro, Rouba, Emory University School of Medicine, Atlanta, Georgia, United States

Rouba Garro, MD

• Winterberg, Pamela D., Emory University School of Medicine, Atlanta, Georgia, United States

Pamela D. Winterberg,

• Kelleman, Mike, Emory University School of Medicine, Atlanta, Georgia, United States

Mike Kelleman,

• George, Roshan P., Emory University School of Medicine, Atlanta, Georgia, United States

Roshan P. George,

• Matossian, Debora, Lurie Children's Hospital, Chicago, Illinois, United States

Debora Matossian,

• Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States

Joseph T. Flynn,

• Hooper, David K., Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, United States

David K. Hooper,

Background

In 2017, pediatric hypertension (HTN) guidelines were updated with 2 major changes compared to the 2004 NHBPEP 4th Report: normative blood pressure (BP) values excluded overweight children and simplified staging was provided for children ≥13 yo using the adult nominal cutoffs. This study evaluated the effect of the new guidelines on BP staging in children with kidney transplant (KT) using registry data from the Improving Renal Outcomes Collaborative (IROC).

Methods

We examined the last accurate BP measurement for patients <18 yo and >90 days post-KT in the IROC registry and compared BP staging using percentile (%tile) cutoffs in the 4^thReport versus 2017 AAP HTN Guidelines. BP staging using AAP %tile versus adult nominal cutoffs for children ≥13 yo were also compared. Associations between overweight or short stature and change in BP staging were assessed with Chi-square tests, odds ratios (OR), and 95% confidence intervals (CI).

Results

A total of 563 patients met inclusion criteria. When applying AAP %tile cutoffs, 71/563 (13%) had increased BP stage compared to 4^th Report classification, with most changing from normal to elevated or pre-HTN to stage 1 (see table). Overweight/obese children were more likely to have increased staging using AAP %tiles (OR 1.7, CI 1.05-2.90) compared to 4th Report cutoffs. When applying adult cutoffs for children ≥13 yo, BP stage decreased in 13% (31/241) compared to the %tile cutoffs in the AAP Guidelines. This age group had below-average height (median height %tile 11.2, IQR 1.9-38.5). Height percentile was a significant risk factor for decreased BP stage using adult cutoffs (p=0.01).

Conclusion

Short stature and obesity, which are common in pediatric KT recipients, affect BP staging when applying updated HTN guidelines. The application of adult BP cutoffs in children with kidney transplant ≥13yo may under-report uncontrolled BP, especially in those with short stature. Transplant physicians may consider applying percentile-based cutoffs until adulthood in this population with high cardiovascular risk.

Funding

• NIDDK Support