Indicator Details — Children and Adolescents: Nephrotic-range Proteinuria Associated with Poor Blood Pressure Control in Children with CKD
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  Source
  • CKiD

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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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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. 2014;85(4):938-944
http://www.ncbi.nlm.nih.gov/pubmed/24048375
FieldData
Description of MeasureBlood pressure control 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 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)
NumeratorAll participants with a GFR of 30-90 ml/min/1.73 m² who had controlled blood pressure over the follow-up period
DenominatorAll participants with a GFR of 30-90 ml/min/1.73 m²
Definition of CKDSchwartz-estimated GFR of 30-90 ml/min/1.73 m² (for entry into study)
Glomerular filtration rateMeasured, by iohexol
Primary Data Source IndicatorBlood pressure control over follow-up period
Primary Indicator Method of MeasurementAt 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 IndicatorUrine protein: creatinine ratio
Secondary Indicator Method of MeasurementFirst-morning urine samples collected at each study visit
Frequency of Measurement (Primary)Baseline, 6-month visit, and annually thereafter
Period Currently Available2010
Pending DataNone
U.S. Region Covered by Primary VariableAll
Additional Data Items of InterestSex, age, underlying CKD diagnosis, self-reported history of hypertension
Limitations of IndicatorBlood pressure measured at the time of the study visit may not accurately reflect the participant's normal blood pressure
Analytical ConsiderationsAs 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.
    http://www.ncbi.nlm.nih.gov/pubmed/24048375
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd