Nephrotic-range proteinuria was shown to be the strongest risk factor for poor blood pressure control in children with CKD, after adjusting for clinical and demographic factors (relative sub-hazard (RSH) =0.19 for a urine protein to creatinine ratio (uP/C) >2 compared to normal range). Black race and a GFR <40 ml/min/1.73m2 also presented as risk factors for hypertension (RSH=0.42 and 0.58, respectively).
Chart Explanation: Nephrotic-range proteinuria is a significant independent predictor of elevated blood pressure in children with CKD. The relative sub-hazards (RSH) for achieving normal blood pressure were determined for 207 children in the Chronic Kidney Disease in Children (CKiD) cohort. All children assessed had elevated blood pressure. Nephrotic-range proteinuria was shown to be the strongest risk factor for poor blood pressure control in children with CKD, after adjusting for clinical and demographic factors (RSH=0.19 for a uP/C>2 compared to normal range). Black race and a GFR <40 ml/min/1.73m2 also presented as risk factors for poor blood pressure control in the examined population (RSH=0.42 and 0.58, respectively). Urine samples and blood pressure readings were taken longitudinally. Blood pressure measurements were standardized for age, gender, and height.
The Chronic Kidney Disease in Children (CKiD) study is a prospective observational study of an estimated 500 children aged 1 to 16 years at 48 North American centers with varying degrees of CKD severity, which was designed to measure consequences in pediatric CKD patients. As with all cohort studies, recruitment bias and lack of representativeness may influence estimates.
This indicator is based upon analysis in published literature: Kogon AJ, Pierce CB, Cox C, et al. Nephrotic-range proteinuria is strongly associated with poor blood pressure control in pediatric chronic kidney disease. Kidney Int
|Description of Measure||Blood pressure control among children with CKD|
|Data Source||CKiD prospective observational cohort study|
|Type of Data Source||Private|
|Data Set||CKiD summarized data|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Children aged 1 to 16 year with mild to moderate CKD (Schwartz-estimated GFR of 30-90 ml/min/1.73 m²) who are treated throughout 48 pediatric nephrology centers in North America (46 U.S., 2 Canadian centers)|
|Numerator||All participants with a GFR of 30-90 ml/min/1.73 m² who had controlled blood pressure over the follow-up period|
|Denominator||All participants with a GFR of 30-90 ml/min/1.73 m²|
|Definition of CKD||Schwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)|
|Glomerular filtration rate||Measured, by iohexol|
|Primary Data Source Indicator||Blood pressure control over follow-up period|
|Primary Indicator Method of Measurement||At each study visit, three BP measurements at 30-second intervals were obtained using the first Korotkoff sound for SBP and the fifth Korotkoff sound for DBP. The average of the three values was taken. Blood pressure measurements were standardized for age, sex, and height. |
|Secondary Data Source Indicator||Urine protein: creatinine ratio|
|Secondary Indicator Method of Measurement||First-morning urine samples collected at each study visit|
|Frequency of Measurement (Primary)||Baseline, 6-month visit, and annually thereafter|
|Period Currently Available||2010|
|U.S. Region Covered by Primary Variable||All|
|Additional Data Items of Interest||Sex, age, underlying CKD diagnosis, self-reported history of hypertension|
|Limitations of Indicator||Blood pressure measured at the time of the study visit may not accurately reflect the participant's normal blood pressure|
|Analytical Considerations||As with all cohort studies, selection bias and possible confounding|
References and Sources:
Kogon AJ, Pierce CB, Cox C, et al. Nephrotic-range proteinuria is strongly associated with poor blood pressure control in pediatric chronic kidney disease. Kidney Int. 2014;85(4):938-944.