Antihypertensive prescription in pediatric dialysis: a practitioner survey by the Midwest Pediatric Nephrology Consortium study

Abstract

Previous studies have indirectly suggested the prescription of antihypertensive medications may contribute to blood pressure control in dialysis patients. Before exploring this largely unknown field, it is necessary to examine if there is diversity in antihypertensive prescription for dialysis patients. The questionnaire by the Midwest Pediatric Nephrology Consortium was mailed to members of American Society of Pediatric Nephrology holding faculty positions in North America and Puerto Rico. Eighty-three (23.9%) of the mailed 357 surveys were analyzable. End-organ damage (43.2% respondents), interdialytic blood pressure levels (35.1%), achievement of dry weight (29.7%), duration of action of medications (25.7%), and underlying diseases (24.3%) were considered as the most important factor(s) in determining antihypertensive medications. For both hemodialysis and peritoneal dialysis patients, dihydropyridine-calcium channel blockers and angiotensin enzyme inhibitors were the most commonly prescribed medications. On scheduled hemodialysis days, 66.7% respondents withheld morning medications. Among them, two-thirds did not withhold all medications; they preferred withholding direct vasodilators (63.2%) > dihydropyridine-calcium channel blockers (50%) > beta-blockers (25%) > angiotensin enzyme inhibitors (21.9%). 60.7% respondents gave medications back postdialysis and 66.1% held medications only for morning dialysis. For nocturnal peritoneal dialysis patients, 85.9% and 91.1% respondents did not avoid certain medications in the evening and morning, respectively. For continuous ambulatory peritoneal dialysis patients, 10.8% respondents preferred giving medications in the morning while 74.3% had no preference. Antihypertensive prescription is quite diverse among pediatric nephrologists and its clinical significance requires further studies.