Long-term kidney outcomes in children and adolescents with hypertension: a propensity-matched cohort study

Junayd Hussain¹, Kalina Georgieva¹, Cal H Robinson², Nivethika Jeyakumar³, Graham Smith³, Tammy Brady⁴, Allison Dart⁵, Janis Dionne⁶, Sabine Karam⁷, Ashlene M McKay⁸, Rulan Parekh⁸, Rukshana Shroff⁹, Manish D Sinha¹⁰, Andrew M South¹¹, Carol Vincent¹¹, Manish M Sood¹², Rahul Chanchlani¹³

Affiliations

¹ Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
² Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
³ Lawson Health Research Institute and London Health Sciences Centre, London, ON, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Hamilton, ON, Canada.
⁴ Department of Pediatrics, Division of Nephrology, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁶ Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.
⁷ Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁸ Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
⁹ University College London Great Ormond Street Hospital, and Institute of Child Health, London, UK.
¹⁰ Department of Pediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK.
¹¹ Department of Pediatrics, Atrium Health Levine Children's Hospital, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
¹² Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹³ ICES (formerly the Institute for Clinical Evaluative Sciences), Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: chanchlr@mcmaster.ca.

PMID: 40578375
DOI: 10.1016/S2352-4642(25)00127-0

Long-term kidney outcomes in children and adolescents with hypertension: a propensity-matched cohort study

Junayd Hussain et al. Lancet Child Adolesc Health. 2025 Aug.

. 2025 Aug;9(8):553-564.

doi: 10.1016/S2352-4642(25)00127-0. Epub 2025 Jun 24.

Authors

Affiliations

¹ Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
² Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
³ Lawson Health Research Institute and London Health Sciences Centre, London, ON, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Hamilton, ON, Canada.
⁴ Department of Pediatrics, Division of Nephrology, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁶ Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.
⁷ Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁸ Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
⁹ University College London Great Ormond Street Hospital, and Institute of Child Health, London, UK.
¹⁰ Department of Pediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK.
¹¹ Department of Pediatrics, Atrium Health Levine Children's Hospital, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
¹² Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹³ ICES (formerly the Institute for Clinical Evaluative Sciences), Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: chanchlr@mcmaster.ca.

PMID: 40578375
DOI: 10.1016/S2352-4642(25)00127-0

Abstract

Background: Hypertension affects 6% of all children and adolescents, is increasing in prevalence, and is associated with adverse cardiovascular outcomes. In childhood chronic kidney disease, hypertension is associated with progression to kidney failure. However, direct evidence linking childhood hypertension with long-term adverse kidney outcomes is scarce. We aimed to determine the long-term risk of major adverse kidney events (MAKEs) among children and adolescents diagnosed with hypertension.

Methods: In this population-based retrospective cohort study, we assessed data from all children and adolescents (aged 3-18 years) diagnosed with hypertension from April 1, 1996, to March 31, 2023, in Ontario, Canada, using validated case definitions in health administrative databases. Each case was propensity score-matched with up to five controls without hypertension by age, sex, birthweight, maternal gestational hypertension, pre-existing diabetes, previous cardiovascular surgery, obesity, previous acute kidney injury, and a propensity score for hypertension diagnosis. The primary outcome was major adverse kidney events (MAKEs; ie, all-cause mortality, incident chronic kidney disease, or kidney failure defined as start of chronic dialysis or receipt of kidney transplantation), assessed using weighted Cox regression using robust variance estimators to estimate hazard ratios (HRs) and 95% CIs.

Findings: 26 324 children and adolescents with hypertension were matched with 126 834 controls without hypertension, who were balanced on baseline covariates by propensity score matching. For children and adolescents with hypertension, median age at entry was 15 years (IQR 12-17), there were 10 868 (41·3%) females and 15 456 (58·7%) males, and previous personal and maternal comorbidities were uncommon (1169 [4·4%] had congenital heart disease, 1787 [6·8%] malignancy, 432 [1·6%] diabetes, 2356 [9·0%] complex chronic conditions, and 379 [3·0%] born to mothers with hypertension). During a median 14·2-year follow-up (IQR 7·4-20·7) in the hypertension cohort and 13·7-year follow-up (7·1-21·2) among controls, MAKE incidence was 5·52 per 1000 person-years (95% CI 5·28-5·76) in children and adolescents with hypertension versus 1·66 per 1000 person-years (1·60-1·72) in matched non-hypertensive controls (7·7% vs 2·4%; HR 3·03 [95% CI 2·86-3·21]).

Interpretation: Children and adolescents diagnosed with hypertension are at greater long-term risk of MAKEs compared with non-hypertensive controls. Improved recognition and control of paediatric hypertension might prevent progressive kidney dysfunction. These findings should be confirmed by large-scale, well-controlled prospective studies.

Funding: Department of Pediatrics at McMaster University.

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Conflict of interest statement

Declaration of interests AMS received grant funding from the National Institutes of Health, as well as consulting fees from serving on the Advisory Board of IDORSIA Pharmaceuticals US, Kyowa Kirin, and Conjupro Biotherapeutics. AMS also serves on the AHA Council as a Committee Chair. All other authors declare no competing interests.

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Long-term kidney outcomes in children and adolescents with hypertension: a propensity-matched cohort study

Affiliations

Long-term kidney outcomes in children and adolescents with hypertension: a propensity-matched cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous