Antihypertensive medications were received at baseline by 68% and 53% of pediatric CKD patients with systolic and diastolic blood pressure ≥90th percentile, respectively.
Among those CKD pediatric patients treated with antihypertensive medications, the percentages of male and black patients were significantly higher among those with uncontrolled blood pressure (systolic or diastolic blood pressure ≥90th percentile) than among those with controlled blood pressure.
Chart Explanation: Antihypertensive medications were received at baseline by 68% and 53% of pediatric CKD patients with systolic and diastolic blood pressure ≥90th percentile, respectively. Among those treated with medications, male and black patients were significantly more likely to be uncontrolled (systolic or diastolic blood pressure ≥90th percentile); Hispanic, obese patients, and patients with glomerular diagnoses were more likely to be uncontrolled but the differences were not statistically significant. Those using angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARB) were more likely to be controlled, whereas those using calcium channel blockers or other antihypertensive medications were less likely to be controlled. Use of two or more medications was associated with a non-significantly greater likelihood of blood pressure control.
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, iohexol GFR as well as known gender, age, and diagnosis. Complete methods can be found in Flynn et al. (2008).
|Description of Measure||Treatment of blood pressure 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 (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)|
|Numerator||Enrolled children with abnormal measured auscultatory blood pressure, iohexol GFR as well as known gender, age, and diagnosis|
|Denominator||Enrolled children with measured auscultatory blood pressure, iohexol GFR as well as known gender, age, and diagnosis|
|Definition of CKD||Schwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)|
|Primary Data Source Indicator||Medications|
|Primary Indicator Method of Measurement||Self-reported (interview)|
|Secondary (1) Variable||Blood pressure|
|Secondary (1) Indicator Method of Measurement||Auscultatory 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 Variable||All|
|Period Currently Available||2004–2008|
|Pending Data||None for baseline; further visits scheduled|
|Additional Data Items of Interest||Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, diagnosis)|
|Limitations of Indicator||Error in medication self-report; error in blood pressure measurement; possibility of white coat hypertension and masked hypertension|
|Analytical Considerations||Data 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.