Blood pressure control in pediatric hemodialysis: data from the SCOPE collaborative.

backgroundThe Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative is a quality improvement initiative focused on improving care of children on dialysis. Accurate blood pressure (BP) measurement is a focus of SCOPE as cardiovascular disease is a leading cause of morbidity and mortality.

methodsAn analysis of children from 25 pediatric hemodialysis (HD) centers enrolled in SCOPE was conducted to describe prevalence of high BP and hypertension and assess risk factors for hypertension. Data on patient characteristics, including age, renal diagnosis, race, sex, and use of antihypertensive medications was collected. Based on 2017 AAP hypertension guidelines, patients were classified as having uncontrolled, controlled or untreated BP as well as persistent hypertension. Generalized linear modeling was used to evaluate associations between patient characteristics and persistent hypertension.

resultsA total of 3532 BP evaluation forms from 407 HD patients were collected, providing 6962 BP measurements. 54.3% of BP measurements were abnormal with 25.4% classified as stage I hypertension and 16.3% as stage II hypertension. Across 3532 forms, 47.7% showed uncontrolled BP, 13.8% showed untreated hypertension and 37.1% had persistent hypertension. There were no significant associations of age, renal diagnosis, race or sex with persistent hypertension.

conclusionsPrevalence of uncontrolled and untreated hypertension is high among patients on HD in the SCOPE collaborative, despite frequent use of antihypertensive therapy. This mirrors results from other registry studies but is more robust due to use of repeated measurements, standardized measurement procedures and use of post-HD measurements for classification of hypertension.