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Kidney Week

Abstract: TH-PO494

Blood Pressure Control in Pediatric Hemodialysis: Data from the SCOPE Collaborative

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Brunson, Celina, Children's National Hospital, Washington, District of Columbia, United States
  • Richardson, Troy, Children's Hospital Association, Overland Park, Kansas, United States
  • Claes, Donna J., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Wasik, Heather L., SUNY Upstate Medical University, Syracuse, New York, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Swartz, Sarah J., Texas Children's Hospital, Houston, Texas, United States
  • Ruebner, Rebecca, Johns Hopkins University, Baltimore, Maryland, United States
  • Weaver, Donald J., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Neu, Alicia, Johns Hopkins University, Baltimore, Maryland, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
Background

The Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) Collaborative is a quality improvement initiative focused on improving care of children on dialysis. Accurate blood pressure (BP) measurement is a focus of SCOPE as hypertension and cardiovascular disease is a leading cause of morbidity and mortality for children on dialysis.

Methods

Twenty centers collected two post-hemodialysis (HD) BP measurements per week for two weeks of each month using a standardized procedure (BP measurement bundle) to characterize the BP of children on HD from 4/1/2019-3/31/2022. The measurements were conducted via either oscillometric or manual methods. Hypertension was classified using the 2017 AAP hypertension guidelines.

Results

A total of 2,390 BP evaluation forms from 294 HD patients >3 years of age have been submitted to date. There were 4,713 weekly BP measurements. 1,457 (31%) measurements were from patients aged 3-12 years and 3,256 (69%) measurements were from patients aged 13 years and older. BP medications were prescribed at the time of 56% of measurements. Overall, 2,432 (52%) of the BP readings were abnormal. The majority (58.5%) of measurements in the 3-12 year olds were consistent with either Elevated, Stage I or Stage II hypertension. In the patients 13 years and older, 48.5% of measurements were abnormal, with 35% of the readings in Stage I/II hypertension. More than 70% of the abnormal readings were based only on oscillometric measurement. 891 (18.9%) of all BP measurements were manual. In 41% of instances when a manual BP was repeated after an oscillometric reading, the BP classification changed, in 33% there was an increase in the BP classification, while the classification improved in 67% of cases.

Conclusion

The prevalence of elevated BP/hypertension is high amongst pediatric HD patients in the SCOPE collaborative when using a standardized BP measurement procedure and despite the use of antihypertensive therapy. While most of the BP classifications were based on oscillometric measurements instead of manual readings, the latter may help inform treatment decisions. Additional efforts by SCOPE will help to further define a clinically practical strategy for BP assessment in children on HD as a prelude to addressing therapeutic BP management.