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Cao D, Chen Y, Gao X, Zhu Y, Wu D, Liu G. Hypertension in 172 Chinese Children: An 8-Year Retrospective Study. J NIPPON MED SCH 2021; 88:178-188. [PMID: 34193741 DOI: 10.1272/jnms.jnms.2021_88-301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We evaluated children with hypertension and compared those with essential and secondary (including renal and non-renal) hypertension. METHODS This retrospective study analyzed data from hypertensive children (age, 0-18 years) referred for treatment between January 2008 and December 2015. Demographic factors, causative factors, and medical treatments were evaluated. Treatment failure was defined as a systolic or diastolic blood pressure ≥95th percentile for age, gender, and height on three separate occasions, despite treatment. All patients not meeting the failure criteria were considered to have controlled hypertension. The control rate was defined as the proportion of patients with controlled blood pressure. RESULTS Among 172 consecutive patients, 28% had essential hypertension and 72% had secondary hypertension. As compared with children with secondary hypertension, those with essential hypertension had a higher frequency of family history of hypertension (P<0.001), a higher body mass index (BMI) (P=0.001), lower frequency of proteinuria (P=0.003), lower uric acid (P=0.04), and lower triglyceride (P=0.048). The medications used in the controlled group were similar to those used in the uncontrolled group. Angiotensin-converting enzyme inhibitors (ACEIs) were only used in nephrogenic patients, and a higher rate of ACEI use seemed to increase control rates. Control rates did not significantly differ by age, number of drugs, or cause of hypertension. CONCLUSIONS As compared with children with secondary hypertension, those with essential hypertension were more likely to have a family history of hypertension and had a higher BMI, lower frequency of proteinuria, and lower uric acid and triglyceride concentrations. Treatment guidelines for essential and secondary hypertension should be established for children of all ages.
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Affiliation(s)
- Di Cao
- Medical Affairs Department, Children's Hospital of Fudan University
| | - Yewei Chen
- Department of Pharmacy, Children's Hospital of Fudan University
| | - Xuan Gao
- Department of Pharmacy, Children's Hospital of Fudan University
| | - Yiqing Zhu
- Department of Pharmacy, Children's Hospital of Fudan University
| | - Dan Wu
- Department of Pharmacy, Children's Hospital of Fudan University
| | - Gongbao Liu
- Medical Affairs Department, Children's Hospital of Fudan University
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Zhang H, Tao Y, Wang Z, Lu J. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine (Baltimore) 2019; 98:e16713. [PMID: 31441844 PMCID: PMC6716681 DOI: 10.1097/md.0000000000016713] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the nutritional status of children with chronic kidney disease (CKD) before dialysis via a series of indexes, and investigate the prognostic impact of nutritional status in these patients assessed by the Prognostic Nutritional Index (PNI).Fifty-four children with CKD before dialysis were enrolled in this study. The nutritional status was evaluated by different indexes, including dietary intake, anthropometry data and biochemical parameters. Additionally, PNI is calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (/mm). Glomerular filtration rate (GFR) of patients with different PNI scores was followed up.Thirty-four patients (63.0%) experienced unreasonable dietary intake, and the patients with CKD stage 4 were characterized by lower energy intake. The height was the most affected anthropometry parameter. Additionally, 46 patients (85.2%) suffered from anemia. The serum albumin of 42 patients (77.8%) was <35 g/L, while 34 cases (63.0%) had increased cholesterol and triglyceride. According to the PNI scores, the patients were divided into 3 groups: high-PNI (PNI ≥ 38), middle-PNI (35 ≤ PNI < 38), and low-PNI (PNI < 35). Of the 54 patients, the PNI was <35 in 29 (53.7%) and ≥38 in 13 (24.1%). The patients with CKD stage 4 were belonged to the low-PNI group. At follow-up, GFR decreased significantly in patients with low-PNI scores compared with the high-PNI group (P < .05).Malnutrition, as a common complication of CKD, has a prognostic impact in children with CKD before dialysis, as assessed by the PNI score.
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Affiliation(s)
- Hui Zhang
- Department of Pediatrics, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yuhong Tao
- Department of Pediatrics, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zheng Wang
- Department of Pediatrics, West China Second University Hospital of Sichuan University
| | - Jing Lu
- Department of Pediatrics, West China Second University Hospital of Sichuan University
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Gallibois CM, Jawa NA, Noone DG. Hypertension in pediatric patients with chronic kidney disease: management challenges. Int J Nephrol Renovasc Dis 2017; 10:205-213. [PMID: 28794651 PMCID: PMC5538700 DOI: 10.2147/ijnrd.s100891] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem.
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Affiliation(s)
- Claire M Gallibois
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natasha A Jawa
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Damien G Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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Kim H, Lim H, Choue R. Compromised Diet Quality is Associated with Decreased Renal Function in Children with Chronic Kidney Disease. Clin Nutr Res 2014; 3:142-9. [PMID: 25136542 PMCID: PMC4135242 DOI: 10.7762/cnr.2014.3.2.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 01/24/2023] Open
Abstract
Nutritional status of children with chronic kidney disease (CKD) is important since it affects growth and development. This study was to investigate overall diet quality measured by nutrient intake adequacy, nutrient density, and several dietary habits in children with CKD and its relationship with clinical parameters according to glomerular filtration rate (GFR). Assessment of nutritional status and diet quality was conducted in nineteen children with CKD. Average Z-scores of height, weight and body mass index (BMI) in the participants were less than standard growth rate. Nutritional status, such as Z-scores of height (p < 0.05) and serum total protein (p < 0.05), were significantly lower in the children with GFR < 75 mL/min/1.73 m2 compared to those with GFR ≥ 75 mL/min/1.73 m2. Nutrition adequacy ratio of energy, thiamin, riboflavin, vitamin B6, folate, iron, and zinc and overall diet quality were significantly poorer in the children with GFR < 75 mL/min/1.73 m2. Poorer appetite and avoidance of food were observed in the children with higher blood urea nitrogen (BUN). Intakes of iron, zinc, thiamin, niacin, and vitamin B6 were positively correlated with GFR. Intakes of calcium, potassium and folate were positively correlated with BUN, while protein intakes were negatively correlated. Overall nutrient intakes were inadequate and diet quality was decreased as kidney function was decreased. Dietary habit and appetite were also related with kidney function in this study subjects. Systemic efforts of nutritional intervention are imperative to prevent deteriorating growth and development and improve the nutritional status in children with CKD.
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Affiliation(s)
- Hyerang Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 446-701, South Korea. ; Research Institute of Medical Nutrition, Kyung Hee University, Seoul 130-701, South Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 446-701, South Korea. ; Research Institute of Medical Nutrition, Kyung Hee University, Seoul 130-701, South Korea
| | - Ryowon Choue
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 446-701, South Korea. ; Research Institute of Medical Nutrition, Kyung Hee University, Seoul 130-701, South Korea
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Mak RH, Cheung WW, Zhan JY, Shen Q, Foster BJ. Cachexia and protein-energy wasting in children with chronic kidney disease. Pediatr Nephrol 2012; 27:173-81. [PMID: 21298504 PMCID: PMC3249542 DOI: 10.1007/s00467-011-1765-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 11/24/2022]
Abstract
Children with chronic kidney disease (CKD) are at risk for "cachexia" or "protein-energy wasting" (PEW). These terms describe a pathophysiologic process resulting in the loss of muscle, with or without loss of fat, and involving maladaptive responses, including anorexia and elevated metabolic rate. PEW has been defined specifically in relation to CKD. We review the diagnostic criteria for cachexia and PEW in CKD and consider the limitations and applicability of these criteria to children with CKD. In addition, we present an overview of the manifestations and mechanisms of cachexia and PEW. A host of pathogenetic factors are considered, including systemic inflammation, endocrine perturbations, and abnormal neuropeptide signaling, as well as poor nutritional intake. Mortality risk, which is 100- to 200-fold higher in patients with end-stage renal disease than in the general population, is strongly correlated with the components of cachexia/PEW. Further research into the causes and consequences of wasting and growth retardation is needed in order to improve the survival and quality of life for children with CKD.
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Affiliation(s)
- Robert H. Mak
- Division of Nephrology, Department of Pediatrics, Rady Children’s Hospital, University of California San Diego, San Diego, CA USA ,University of California San Diego, 9500 Gilman Drive, MCO634, La Jolla, CA 92093-0634 USA
| | - Wai W. Cheung
- Division of Nephrology, Department of Pediatrics, Rady Children’s Hospital, University of California San Diego, San Diego, CA USA
| | - Jian-Ying Zhan
- Children’s Hospital, Zhejiang University, Hangzhou, China
| | - Qian Shen
- Children’s Hospital, Fudan University, Shanghai, China
| | - Bethany J. Foster
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec Canada
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Janjua HS, Mahan JD. Growth in chronic kidney disease. Adv Chronic Kidney Dis 2011; 18:324-31. [PMID: 21896373 DOI: 10.1053/j.ackd.2011.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 01/18/2011] [Accepted: 02/14/2011] [Indexed: 11/11/2022]
Abstract
Poor growth is a common sequela of CKD in childhood. It not only affects the psychosocial development of a child but also has significant effects even in the adult life. The multifactorial etiology and severe consequences of growth failure in CKD warrant evaluation of all the modifiable and nonmodifiable causes. Treatment strategies must be directed toward the specific factors for each child with CKD. Among the various metabolic, nutritional, and hormonal disturbances complicating CKD, disordered growth hormone (GH) and insulin-like growth factor-1 axis are important contributors toward poor growth in children with CKD. CKD is recognized as a state of GH resistance rather than GH deficiency, with multiple mechanisms contributing to this GH resistance. Recombinant GH (rGH) therapy can be used in this population to accelerate growth velocity. Although its use has been shown to be effective and safe in children with CKD, there continues to be some uncertainty and reluctance among practitioners and families regarding its usage, thereby resulting in a surprisingly low use in children with CKD. This review focuses on the pathogenesis of growth failure, its effect, and management strategies in children with CKD.
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Hobbs DJ, Bunchman TE, Weismantel DP, Cole MR, Ferguson KB, Gast TR, Barletta GM. Megestrol Acetate Improves Weight Gain in Pediatric Patients With Chronic Kidney Disease. J Ren Nutr 2010; 20:408-13. [DOI: 10.1053/j.jrn.2010.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Indexed: 11/11/2022] Open
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Mahan JD, Ferris ME. Case-Based Education at the 2009 Pediatric Nephrology Fellows Conference. Ren Fail 2010; 32:14-20. [DOI: 10.3109/08860220903474428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John D. Mahan
- Pediatric Residency Program/Pediatric Nephrology Fellowship Program, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Maria E. Ferris
- Department of Pediatrics/Renal Replacement Therapies Program, University of North Caroline School of Medicine, Chapel Hill, North Carolina, USA
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Caliskan Y, Gorgulu N, Yelken B, Yazici H, Oflaz H, Elitok A, Turkmen A, Bozfakioglu S, Sever MS. Plasma Ghrelin Levels Are Associated with Coronary Microvascular and Endothelial Dysfunction in Peritoneal Dialysis Patients. Ren Fail 2009; 31:807-13. [DOI: 10.3109/08860220903151419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Oliveira JCD, Siviero-Miachon AA, Spinola-Castro AM, Belangero VMS, Guerra-Junior G. [Short stature in chronic kidney disease: physiopathology and treatment with growth hormone]. ACTA ACUST UNITED AC 2009; 52:783-91. [PMID: 18797585 DOI: 10.1590/s0004-27302008000500010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 04/24/2008] [Indexed: 11/22/2022]
Abstract
Growth failure is frequent and a clinically important issue in children with chronic kidney disease (CKD). Many factors contribute to impaired growth in these children, including abnormalities in the growth hormone (GH)--insulin-like growth factor 1 (IGF-1) axis, malnutrition, acidosis, renal bone disease and glucocorticoid associated treatment. The management of growth failure in children with CKD is complicated by the presence of other-disease related complications requiring medical intervention. Despite evidence of GH efficacy and safety in this population, this therapy is still underutilized. This review shows the impact, the causes and the treatment of growth failure in children with CKD.
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