Indicator Details — Children and Adolescents: Percentage of Pediatric CKD Patients with Uncontrolled Hypertensiona
Data Sources
 
Stratification and Year Choices:

  Source
  • CKiD

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Footnotes:
a Controlled hypertension, treated, with systolic and diastolic blood pressure <90th percentile for age, gender and height; uncontrolled hypertension, treated, with systolic or diastolic blood pressure ≥90th percentile. SBP, systolic blood pressure; DBP, diastolic blood pressure; ACE/ARB, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker; CCB, calcium channel blocker; AHM, antihypertensive medication. P from 2 test (category by controlled status). Adapted from Flynn et al. (2008).




Overall, by either systolic or diastolic measurements, 14% of pediatric CKD patients had uncontrolled hypertension, as defined by blood pressure >95th percentile for their age, gender, and height; 11% and 10% had uncontrolled pre-hypertension (≥90th/<95th percentile) by systolic and diastolic blood pressure.

The mean systolic and diastolic blood pressures in these (treated and untreated) patients were 107 and 66 mmHg, respectively.
Chart Explanation: Overall, by either systolic or diastolic measurements, 14% of pediatric CKD patients had uncontrolled hypertension, as defined by blood pressure >95th percentile for their age, gender and height, regardless of treatment; 11% and 10% had uncontrolled pre-hypertension (≥90th/<95th percentile) by systolic and diastolic blood pressure. The mean systolic and diastolic blood pressures in these patients were 107 and 66 mmHg, respectively. Note that these percentages include treated and untreated patients, so they represent uncontrolled (by either lifestyle or medical intervention) hypertension and pre-hypertension.
The Chronic Kidney Disease in Children (CKiD) study is a prospective observational study of an estimated 500 children (1-16 years old) 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.

Analyses for this measure were restricted to the 432 children enrolled in CKiD with measured auscultatory blood pressure (at baseline), iohexol GFR as well as known gender, age, and diagnosis. Complete methods can be found in Flynn et al. (2008).
FieldData
Description of MeasureBlood pressure status among children with CKD
Data SourceCKiD prospective observational cohort study
Type of Data SourcePrivate
Data SetCKiD summarized data
Health Care System DataNo
Regional or National?National
Demographic GroupChildren (1-16 years old) 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)
NumeratorEnrolled children with abnormal measured auscultatory blood pressure, iohexol GFR as well as known gender, age, and diagnosis
DenominatorEnrolled children with measured auscultatory blood pressure, iohexol GFR as well as known gender, age, and diagnosis
Definition of CKDSchwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)
Primary Data Source IndicatorBlood pressure
Primary Indicator Method of MeasurementAuscultatory casual blood pressure, measured by trained investigators using standardized equipment & protocol
Frequency of Measurement (Primary)At all scheduled visits; only baseline presented
U.S. Region Covered by Primary VariableAll
Period Currently Available2004–2008
Pending DataNone for baseline; further visits scheduled
Additional Data Items of InterestStage of CKD, stratification variables of interest (age, gender, race/ethnicity, diagnosis)
Limitations of IndicatorError in blood pressure measurement; possibility of white coat hypertension and masked hypertension
Analytical ConsiderationsData summarized by CKiD investigators (see Flynn et al.); as with all cohort studies, selection bias and possible confounding
References and Sources:
  • Flynn JT, Mitsnefes M, Pierce C, et al.; Chronic Kidney Disease in Children Study Group. Blood pressure in children with chronic kidney disease: A report from the chronic kidney disease in children study. Hypertension. 2008;52(4):631-7.
    http://www.ncbi.nlm.nih.gov/pubmed/18725579
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd