Prevalence of Hypertension in Children with Early-Stage ADPKD

Abstract

Background and objectives: Autosomal dominant polycystic kidney disease is the most common inheritable kidney disease, frequently thought to become symptomatic in adulthood. However, patients with autosomal dominant polycystic kidney disease may develop signs or symptoms during childhood, in particular hypertension. Although ambulatory BP monitoring is the preferred method to diagnose hypertension in pediatrics, data in children with autosomal dominant polycystic kidney disease are limited.

Design, setting, participants, & measurements: Our retrospective multicenter study was conducted to collect ambulatory BP monitoring recordings from patients with autosomal dominant polycystic kidney disease age <18 years old. Basic anthropometric parameters as well as data on kidney function, BP treatment, and kidney ultrasound were also collected.

Results: Data from 310 children with autosomal dominant polycystic kidney disease with a mean age of 11.5±4.1 years old were collected at 22 European centers. At the time when ambulatory BP monitoring was performed, 95% of children had normal kidney function. Reference data for ambulatory BP monitoring were available for 292 patients. The prevalence rates of children with hypertension and/or those who were treated with antihypertensive drugs were 31%, 42%, and 35% during daytime, nighttime, or the entire 24-hour cycle, respectively. In addition, 52% of participants lacked a physiologic nocturnal BP dipping, and 18% had isolated nocturnal hypertension. Logistic regression analysis showed a significant association between a categorical cyst score that was calculated on the basis of the number of cysts >1 cm per kidney and daytime hypertension (odds ratio, 1.70; 95% confidence interval, 1.21 to 2.4; P=0.002), nighttime hypertension (odds ratio, 1.31; 95% confidence interval, 1.05 to 1.63; P=0.02), or 24-hour hypertension (odds ratio, 1.39; 95% confidence interval, 1.08 to 1.81; P=0.01). Kidney length, expressed as SD score, was also significantly associated with nighttime hypertension (odds ratio, 1.23; 95% confidence interval, 1.06 to 1.42; P=0.10).

Conclusions: These data indicate high prevalence of hypertension in children with autosomal dominant polycystic kidney disease starting at young ages.

Keywords: ABPM; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Autosomal Dominant Polycystic Kidney Disease; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Child; Cysts; Humans; Logistic Models; Polycystic Kidney, Autosomal Dominant; Prevalence; Retrospective Studies; Rhythm Analysis; blood pressure; hypertension; kidney; pediatrics.

Graphical abstract

Figure 1.

Cystic changes evaluated by renal ultrasound in 270 participants. The figure shows the relative distribution of cyst classes for each kidney (details are in the text). This classification is on the basis of the number of cysts >1 cm per kidney, and it is used to calculate a “cyst score,” which corresponds to the sum of scores of each kidney.

Figure 2.

Distribution of daytime, nighttime, and 24-hour ambulatory BP monitoring results. Box plots show the medians and interquartile values for BP (A and B) and heart rate (C) expressed as SD score (SDS). Whiskers indicate the 5th and 95th percentiles.

Figure 3.

Influence of the cyst score and kidney length SD score (SDS) on mean arterial pressure (MAP). Box plots show the medians and interquartile values for daytime, nighttime, and 24-hour MAP values for different classes of cyst score (A–C) and kidney length (D–F). Data are expressed as SDS. Whiskers indicate the 5th and 95th percentiles.

Figure 4.

Prevalence of circadian and ultradian rhythms in 137 participants. The figure shows the prevalence of significant rhythms obtained by partial Fourier analysis on 24-hour mean arterial pressure (MAP; A and B) and heart rate (HR; C and D) data. Data are calculated separately for prepubertal (n=62) and pubertal (n=75) children, and they are compared with control children (22). ADPKD, autosomal dominant polycystic kidney disease. *P<0.01; **P<0.001.