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van Gelderen E, Psoter KJ, Faria R, Pruette C, Brady TM. Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring - characteristics associated with inertia and action. Pediatr Nephrol 2024; 39:2725-2732. [PMID: 38761222 DOI: 10.1007/s00467-024-06404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/23/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Ambulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings. METHODS This was a retrospective cross-sectional analysis of patients 5-22 years old who underwent 24-h ABPM between 2003-2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action. RESULTS 115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action. CONCLUSIONS While most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized.
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Affiliation(s)
- Evelien van Gelderen
- Johns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA
| | - Kevin J Psoter
- Johns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA
| | - Rafi Faria
- Johns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA
| | - Cozumel Pruette
- Johns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA
| | - Tammy M Brady
- Johns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA.
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2
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Colleman M, Staessen JA, Allegaert K, Raaijmakers A. Perinatal risk factors of renal outcome in former extremely low birth weight neonates. Eur J Pediatr 2024:10.1007/s00431-024-05730-0. [PMID: 39179893 DOI: 10.1007/s00431-024-05730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 08/06/2024] [Accepted: 08/11/2024] [Indexed: 08/26/2024]
Abstract
Former Extremely Low Birthweight (ELBW) neonates suffer from adverse renal and cardiovascular outcomes later in life. Less is known about additional perinatal risk factors for these adverse outcomes which we have investigated in this study. We compared renal outcome between ELBW children and controls, to find perinatal risk factors for poorer renal outcome and to unveil associations between kidney function and blood pressure. This study included 93 former ELBW children and 87 healthy controls with a mean age of 11 years at assessment. We measured cystatin C-based estimated glomerular filtration rate (eGFR) and blood pressure. Blood pressure and eGFR levels were compared between cases and controls. We subsequently investigated perinatal risk factors for adverse outcome amongst ELBW children. ELBW children have significantly higher blood pressure (mean SBP percentile 75th vs. 47th, p <0.001) and lower mean eGFR (94 vs. 107 ml/min/1.73 m2, p = 0.005) compared to the control group. Elevated blood pressure did not correlate with perinatal characteristics and none of them had microalbuminuria. ELBW children with eGFR <90 ml/min/1.73 m2 were ventilated longer (17 vs. 9 days, p = 0.006), more frequently male (OR = 3.33, p = 0.055) and tended to suffer more from intraventricular hemorrhage (40% vs. 15.8%, p = 0.056). There was no association between blood pressure and kidney dysfunction. CONCLUSIONS Understanding risk profiles for unfavorable outcomes may help to identify children at increased risk for kidney dysfunction. Poorer eGFR was associated with longer ventilation, male sex, and intra-ventricular hemorrhage but not with blood pressure. This knowledge can lead to safer neonatal therapeutic regimens for ELBW infants, a more intensive follow-up and earlier treatment initiation for children at highest risk. WHAT IS KNOWN • Extremely Low Birthweight (ELBW) neonates suffer later in life from adverse renal and cardiovascular outcomes. • Perinatal risk factors that further predict the individual risk for adverse outcomes are not well known. WHAT IS NEW • Poorer eGFR in adolescence was associated with male sex, longer ventilation and intra-ventricular hemorrhage at birth but not with blood pressure. • Former ELBW infants had higher blood pressures compared to controls, but no microalbuminuria. • This knowledge can lead to potential precision medicine, safer neonatal therapeutic regimens for ELBW infants, a more intensive follow-up and earlier treatment initiation for children at highest risk.
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Affiliation(s)
- Marieke Colleman
- Department of Development and Regeneration, University of Leuven, Louvain, Belgium
| | - Jan A Staessen
- Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Research Group, Faculty of Medicine, University of Leuven, Louvain, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, University of Leuven, Louvain, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Louvain, Belgium
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anke Raaijmakers
- Department of Paediatric Nephrology, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, Randwick, NSW, Australia.
- School of Women's and Children's Health, University of New South Wales, Randwick Clinical Campus, Randwick, NSW, Australia.
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Vigraijaroenying K, Pirojsakul K, Katanyuwong P, Tangnararatchakit K, Saisawat P, Chantarogh S, Paksi W, Bunmee U. Control of blood pressure in hypertensive children and adolescents assessed by ambulatory blood pressure monitoring. BMC Pediatr 2024; 24:269. [PMID: 38658852 PMCID: PMC11044297 DOI: 10.1186/s12887-024-04732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There have been few studies evaluating the control of hypertension (HT) in children. This study aimed to assess the control of HT using ambulatory blood pressure monitoring (ABPM) and to compare the parameters between the uncontrolled HT and controlled HT groups. METHODS Hypertensive patients aged ≥ 5 years who underwent ABPM to assess the control of HT were enrolled. Demographics, office blood pressure (BP), ABPM, and echocardiographic data were collected. Controlled HT was defined using a BP goal recommended by the 2016 European Society of Hypertension guidelines. RESULTS There were 108 patients (64.8% males) with a mean age of 14.3 years and 51.9% had primary HT. Controlled HT was detected in 41.1% and 33.3% by office BP and ABPM, respectively. Based on ABPM, there was a greater prevalence of controlled HT in the primary HT than the secondary HT group (44.6% vs. 21.2%, P = 0.01). In the primary HT group, BMI z-score at the last follow-up had a significant decrease in the controlled HT than the uncontrolled HT group (-0.39 vs. 0.01, P = 0.032). Primary HT was negatively associated with uncontrolled HT by ABPM. In addition, ABPM showed greater sensitivity (77.8% vs. 55.8%) and negative predictive value (80.9% vs. 70.8%) to predict LVH than those of office BP measurement. CONCLUSION Only one-third of patients achieved the BP goal by ABPM and most were in the primary HT group. Weight reduction is an important measure of BP control in patients with primary HT to attenuate the risk of LVH.
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Affiliation(s)
- Kevalin Vigraijaroenying
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kwanchai Pirojsakul
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Poomiporn Katanyuwong
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanchana Tangnararatchakit
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pawaree Saisawat
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Songkiat Chantarogh
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Witchuri Paksi
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Uthen Bunmee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Schuchman M, Brady TM, Glenn DA, Tuttle KR, Cara-Fuentes G, Levy RV, Gonzalez-Vicente A, Alakwaa FM, Srivastava T, Sethna CB. Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies. J Nephrol 2024; 37:647-660. [PMID: 38512380 DOI: 10.1007/s40620-024-01919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The prevalence of mental health disorders including anxiety and depression is increasing and is linked to hypertension in healthy individuals. However, the relationship of psychosocial patient-reported outcomes on blood pressure (BP) in primary proteinuric glomerulopathies is not well characterized. This study explored longitudinal relationships between psychosocial patient-reported outcomes and BP status among individuals with proteinuric glomerulopathies. METHODS An observational cohort study was performed using data from 745 adults and children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE). General Estimating Equations for linear regression and binary logistic analysis for odds ratios were performed to analyze relationships between the exposures, longitudinal Patient-Reported Outcome Measurement Information System (PROMIS) measures and BP and hypertension status as outcomes. RESULTS In adults, more anxiety was longitudinally associated with higher systolic and hypertensive BP. In children, fatigue was longitudinally associated with increased odds of hypertensive BP regardless of the PROMIS report method. More stress, anxiety, and depression were longitudinally associated with higher systolic BP index, higher diastolic BP index, and increased odds of hypertensive BP index in children with parent-proxy patient-reported outcomes. DISCUSSION/CONCLUSION Chronically poor psychosocial patient-reported outcomes may be significantly associated with higher BP and hypertension in adults and children with primary proteinuric glomerulopathies. This interaction appears strong in children but should be interpreted with caution, as multiple confounders related to glomerular disease may influence both mental health and BP independently. That said, access to mental health resources may help control BP, and proper disease and BP management may improve overall mental health.
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Affiliation(s)
- Matthew Schuchman
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Division of Nephrology, University of Washington School of Medicine, Spokane, WA, USA
| | - Gabriel Cara-Fuentes
- Section of Pediatric Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Rebecca V Levy
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Agustin Gonzalez-Vicente
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fadhl M Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI, USA
| | - Tarak Srivastava
- Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Christine B Sethna
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA.
- Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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5
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Lelii M, Senatore L, Paglialonga F, Consolo S, Montini G, Rocchi A, Marchisio P, Patria MF. Respiratory complications and sleep disorders in children with chronic kidney disease: A correlation often underestimated. Paediatr Respir Rev 2023; 45:16-22. [PMID: 35534343 DOI: 10.1016/j.prrv.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Chronic Kidney Disease (CKD) is characterized by a progressive and irreversible loss of kidney function which gradually leads to end-stage kidney disease (ESKD). Virtually all the organs are damaged by the toxicity of uremic compounds. The lungs may be affected and the impaired pulmonary function may be the direct result of fluid retention and metabolic, endocrine and cardiovascular alterations, as well as systemic activation of the inflammation. An increased prevalence in sleep disorders (SD) is also reported in patients with CKD, leading to a further negative impact on overall health and quality of life. While these complex relationships are well documented in the adult population, these aspects remain relatively little investigated in children. The aim of this review is to provide a brief overview of the pathophysiology between lung and kidney and to summarize how CKD may affect respiratory function and sleep in children.
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Affiliation(s)
- M Lelii
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy.
| | - L Senatore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy
| | - F Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy.
| | - S Consolo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy.
| | - G Montini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - A Rocchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, via della Commenda 9, 20122 Milan, Italy.
| | - P Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - M F Patria
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy.
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Ramadan Y, Elkoofy N, Sabry S, Mansour G, El-Anwar N. Fatigue assessment and its predictors in pediatric patients with chronic kidney disease stages III to V. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [DOI: 10.1186/s43054-022-00155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Abstract
Background
Chronic fatigue is an intense subjective feeling of mental or physical exhaustion. It influences patients’ daily functioning and quality of life, delays recovery, and increases mortality, especially in chronic kidney disease (CKD) patients. The aim of this study is to assess and determine predictors of chronic fatigue in children with ESRD, dialysis, and pre-dialysis stages that can affect the patients’ quality of life (QOL).
Methods
We conducted a cross-sectional study on 114 patients diagnosed with CKD stages III to V, following at the nephrology outpatient clinic and hemodialysis (HD) unit of Cairo University Children’s Hospital during the period September 2020 till April 2021. Demographic and laboratory data of patients were gathered, and dialytic analysis in the form of frequency, duration of dialysis sessions, and adequacy of hemodialysis was calculated. The fatigue severity score (FSS) questionnaire was used to assess fatigue’s effects on daily functions, querying its relationship to motivation, physical activity, work, family, and social life.
Results
The mean age in the current study was (8.8 ± 1.8) years, with 62% being males. The median FSS score was 5.8, with a higher FSS score in stage V CKD patients. High e-GFR, serum sodium, folic acid, and L-carnitine supplementation all reduced the intensity of fatigue, while prolonged HD duration, acidosis, hypertension, and non-compliance to vitamin D replacement increased tiredness severity.
Conclusion
Routine fatigue assessment and measures to reduce it is a fundamental issue in pediatric CKD patients for better QOL.
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Villasis-Keever MA, Zurita-Cruz JN, Zepeda-Martinez C, Alegria-Torres G, Serret-Montoya J, Estrada-Loza MDJ, Hernández-Hernández BC, Alonso-Flores S, Zavala-Serret M. Adipokines as predictive factor of cardiac function in pediatric patients with chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1120445. [PMID: 36967775 PMCID: PMC10034059 DOI: 10.3389/fendo.2023.1120445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Adipokines are associated with cardiovascular disease; in chronic kidney disease (CKD) patients adipokines could be useful prognostic factors. OBJECTIVES To explore whether leptin and adiponectin in kidney replacement therapy (KRT) children could have a role on their cardiac function, in the long-term. DESIGN Prospective cohort study was performed with pediatric KRT patients, aged 8 to 17 years who were undergoing hemodialysis or peritoneal dialysis. At enrollment, lipid profile, adipokines (leptin, leptin receptor, free leptin, and adiponectin), anthropometric measurements and cardiological evaluation were determined. At two-year follow-up, a new cardiological evaluation was performed. Statistical analysis: Quantitative data are presented as median and interquartile range (IQR). Mann-Whitney U test and Chi-squared were used for the between-group comparison. Multivariate analyzes were performed to determine the association of adipokines levels with ventricular ejection fraction (LEVF). RESULTS We included 56 patients, with a median age of 12.5 years. In the first cardiological evaluation, median LVEF was 70.0% (IQR 61%, 76%), 20 patients (35.7%) had some cardiovascular condition, and 10 (17.8%) altered LVEF. At 24-month follow-up, the median LVEF was 70.5% (IQR 65.1%, 77%), while the delta-LVEF values was 3% (IQR -6.5%, 7%). Delta-LVEF were correlated with baseline adipokines serum levels, and the only positive correlation found was with free leptin (r=0.303, p=0.025). In multivariate analysis, levels of free leptin (Coef. 0.12, p<0.036) and leptin (coef. 1.72, p=0.049), as well as baseline LVEF (Coef. -0.65, p<0.001) were associated with delta-LVEF. CONCLUSIONS Free leptin, leptin and LVEF at the beginning of follow-up were associated with the LVEF decrease at the 24-month follow-up in KRT children.
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Affiliation(s)
- Miguel Angel Villasis-Keever
- Research Unit in Analysis and Synthesis of the Evidence, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jessie Nallely Zurita-Cruz
- Hospital Infantil de Mexico Federico Gómez, Facultad de Medicina Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
- *Correspondence: Jessie Nallely Zurita-Cruz,
| | - Claudia Zepeda-Martinez
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gabriela Alegria-Torres
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juana Serret-Montoya
- Adolescent Medicine Service, Hospital Infantil de Mexico Federico Gómez, Ministry of Health, Secretaria de Salud (SSA), Mexico City, Mexico
| | - Maria de Jesus Estrada-Loza
- Department of Pediatric Cardiology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Beatriz Carolina Hernández-Hernández
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sara Alonso-Flores
- Department of Pediatric Nephology, Children’s Hospital, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Monica Zavala-Serret
- Adolescent Medicine Service, Hospital Infantil de Mexico Federico Gómez, Ministry of Health, Secretaria de Salud (SSA), Mexico City, Mexico
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Lobitz CA, Yamaguchi I. Lifestyle Interventions for Elevated Blood Pressure in Childhood-Approaches and Outcomes. Curr Hypertens Rep 2022; 24:589-598. [PMID: 35972678 DOI: 10.1007/s11906-022-01217-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of existing and emerging lifestyle treatments in the clinical management of primary elevated blood pressure and hypertension in pediatric patients. The authors hope to expand the knowledge base surrounding pediatric hypertension and update clinicians on best practices to improve outcomes. RECENT FINDINGS Elevated blood pressure is traditionally addressed with broad lifestyle recommendations such as limiting salt consumption and losing weight. This approach is not well adapted for pediatric patients. Novel and often underutilized approaches to the treatment of hypertension in pediatrics include psychological counseling for behavior modification, circadian nutrition, consistent use of interdisciplinary teams, manipulation of macronutrients, stress management, technology-infused interventions, and systemic changes to the food environment. Elevated blood pressure is a pervasive condition affecting cardiovascular disease and mortality risk. Increasingly, pediatric patients are presenting with elevated blood pressure with etiologies known to be affected by lifestyle behaviors. Weight management, dietary modifications, and daily physical activity are well-researched methods for improving individual blood pressure measurements. These strategies can sometimes be as effective as pharmacological interventions at lowering blood pressure. However, compliance with these individual recommendations is not consistent and has led to unsatisfactory results. There are emerging treatment trends that may provide non-traditional and more effective non-pharmacologic routes to blood pressure management in pediatric patients.
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Affiliation(s)
- C Austin Lobitz
- Pediatric Nephrology, University Health System, San Antonio, TX, USA.
| | - Ikuyo Yamaguchi
- Pediatric Nephrology, University of Oklahoma Health Science Center and Oklahoma Children's Hospital, OU Health, Oklahoma City, OK, USA
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Wijaya EA, Solek P, Hakim DDL, Rossanti R, Widiasta A, Hilmanto D. Factors Affecting Neurocognitive Function in Children with Chronic Kidney Disease: A Systematic Review. Int J Nephrol Renovasc Dis 2022; 15:277-288. [PMID: 36329897 PMCID: PMC9624145 DOI: 10.2147/ijnrd.s375242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose In children, chronic kidney disease (CKD) has been known to affect neurocognitive function which can impair the quality of life. This study aims to determine the factors and treatment modalities which might affect neurocognitive function in pediatric population with CKD. Patients and Methods A systematic review was done using 3 electronic databases: PubMed, ScienceDirect, SpringerLink, and carried out based on PRISMA guidelines. Our review included articles published in the last 10 years (2011–2021) in English, on children aged 0–18 years with CKD. Factors affecting the children’s neurocognitive function were assessed. Results Eight articles were included in this study. Three articles reported that parent’s education, especially maternal education affect the neurocognitive function of children with CKD. In relation with modalities, in general, children with CKD who had kidney transplant had a better neurocognitive outcome. A longer duration of hemodialysis (HD) was associated with poorer neurocognitive outcomes. Other factors that can affect the neurocognitive function included depression, a history of abnormal births, seizures, and hypertension. Conclusion In children, CKD might cause neurocognitive function disorders through various complex and interconnected mechanisms. Further studies are needed to determine the mechanism and prevention of neurocognitive disorders, as well as the best choice of therapeutic modality to improve both kidney function and neurocognitive function in children with CKD.
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Affiliation(s)
- Elrika A Wijaya
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Purboyo Solek
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dzulfikar D L Hakim
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rini Rossanti
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Ahmedz Widiasta
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dany Hilmanto
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia,Correspondence: Dany Hilmanto, Tel +628122266879, Email
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10
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Son R, Suh SY, Cho YS, Rhie SJ. Long-Term Survival and Kidney Function in Pediatric Patients Following Liver Transplantation: A 15-Year Retrospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101544. [PMID: 36291480 PMCID: PMC9600481 DOI: 10.3390/children9101544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023]
Abstract
Long-term preservation of kidney function after liver transplantation (LT) has not been well studied. We thus evaluated the rates of kidney function preservation and long-term survival after pediatric LT. We also investigated the risk factors associated with the progression of chronic kidney disease (CKD). We conducted a retrospective study of 184 pediatric patients who had undergone LT from 2003 to 2018 at a university hospital. We collected demographics, primary indications for LT, liver disease scores, renal function test results, immunosuppressive drug prescriptions, and diagnosis of post-LT complications. The 15-year survival rate was 90.8%. Furthermore, the rate of kidney function preservation at 14 years post-LT in patients at high risk of renal disease was 79.3%, and that in those with less risk of kidney diseases was 96.0%. Arterial hypertension was an independent risk factor associated with CKD progression. However, when arterial hypertension was excluded, the use of cyclosporine and liver disease with renal involvement were risk factors for CKD progression. We found that kidney function after pediatric LT was well preserved. We encourage the early detection of underlying kidney involvement, routine monitoring of renal function for high-risk patients, active control of hypertension, and appropriate immunosuppressive regimens for pediatric patients with LT.
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Affiliation(s)
- Rin Son
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul 03760, Korea
- Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sung Yun Suh
- Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Yoon Sook Cho
- Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sandy Jeong Rhie
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul 03760, Korea
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
- Correspondence:
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11
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Nair N, Kalra R, Chandra Bhatt G, Narang A, Kumar G, Raina R. The Effect and Prevalence of Comorbidities in Adolescents With CKD and Obesity. Adv Chronic Kidney Dis 2022; 29:251-262. [PMID: 36084972 DOI: 10.1053/j.ackd.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/11/2022]
Abstract
Adolescent obesity and CKD are both significant public health issues independently. When seen as comorbid conditions, they can cause deleterious health outcomes that put them on the fast track to necessitate dialysis or transplantation. This paper analyzes the effects of various biomarkers and comorbidities seen in the intersection of obesity and CKD in the adolescent population. We illustrate the estimated prevalence of these biomarkers and comorbidities through a review of the literature, available treatment, and obesity-related glomerulopathies. We found significant prevalence of the biomarkers, microalbuminuria (9.42% ± 9.31% and interquartile range [IQR] of 9.5%), hypertension (23.60% ± 22.5% and IQR of 9.5%), low high-density lipoprotein (14.34% ± 5.46% and IQR of 5%), hyperfiltration (3.12% ± 5.16% and IQR of 4%), and lower estimated glomerular filtration rate 4.59 ± 2.75 and IQR of 3%. Identification of prevalent biomarkers and their manifestations can serve to inform clinicians what to look for in daily setting and help elucidate the magnitude of this growing issue. Additionally, pertinent treatment options from pharmacotherapy to bariatric surgery are outlined to provide care providers with the full spectrum of treatment options for obesity in adolescent populations.
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Affiliation(s)
- Nikhil Nair
- Department of Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Riti Kalra
- Department of Biology, Case Western Reserve University, Cleveland, OH
| | | | - Aarushi Narang
- Department of Pediatrics, ISN-SRC Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Gurinder Kumar
- Department of Pediatrics, The Metrohealth System, Cleveland, OH
| | - Rupesh Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH; Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH.
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12
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Alhamed AA, Toly VB, Hooper SR, Dell KM. The link between executive function, socio-emotional functioning and health-related quality of life in children and adolescents with mild to moderate chronic kidney disease. Child Care Health Dev 2022; 48:455-464. [PMID: 34893999 DOI: 10.1111/cch.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and adolescents with mild to moderate chronic kidney disease (CKD) are at high risk for mild but persistent impairment in executive functions, which have been associated with low health-related quality of life (HRQOL) among children and adolescents with chronic health conditions. However, no similar link has been established among children and adolescents with mild to moderate CKD. Given the essential role executive functions play in the development of adequate cognitive, emotional and social skills, it is essential to gain a clearer understating of the magnitude and attributes of executive functions and its link to HRQOL in order to inform appropriate medical and educational interventions for this patient population. OBJECTIVE The aim of this study is to examine the relationship between executive functions, socio-emotional functioning and HRQOL in children and adolescents with mild to moderate CKD. METHODS A cross-sectional design was used for this secondary data analysis of 199 children and adolescents (ages 6-17) with mild to moderate CKD from the United States and Canada who receive care at hospitals associated with the Chronic Kidney Disease in Children Study (CKiD). RESULTS The presence of impairment in executive functions and socio-emotional functioning (internalizing problems) significantly predicted lower HRQOL after controlling for key covariates (i.e., maternal education, anaemia and hypertension). Further, internalizing problems partially mediated the relationship between executive functions and HRQOL such that impairment in executive functions predicted lower HRQOL directly and indirectly by contributing to higher internalizing problems, which further contributed to low HRQOL. CONCLUSION This study underscores the importance of executive functions and socio-emotional functioning in the manifestation of HRQOL. Given that HRQOL is potentially compromised for many children and adolescents with mild to moderate CKD, it will be important for both clinicians and researchers to examine a range of factors, including executive functions and socio-emotional functioning, in order to optimize HRQOL.
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Affiliation(s)
- Arwa A Alhamed
- Nursing Department, College of Nursing, King Saud bin Abdulaizz University for Health Sciences, Riyadh, Saudi Arabia
| | - Valerie B Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine M Dell
- Pediatric Institute, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
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13
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Jankauskiene A, Drozdz D, Wasilewska A, de Paula-Bernardes R, Glazer R, Valentin M, Tan M, Chiang Y, Bapatla K. Efficacy and safety of valsartan in children aged 1-5 years with hypertension, with or without chronic kidney disease: a randomized, double-blind study followed by open-label phase. Curr Med Res Opin 2021; 37:2113-2122. [PMID: 34543161 DOI: 10.1080/03007995.2021.1982681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the dose-response relationship for reduction in mean systolic blood pressure (MSBP) with valsartan solution, in young children with hypertension with or without chronic kidney disease (CKD). METHODS In this multicenter, randomized, double-blind, double-dummy study, 127 young children aged 1-5 years with hypertension (MSBP ≥95th percentile) were randomized (1:1) to receive valsartan 0.25 or 4 mg/kg/day for 6 weeks, followed by a 20 week open-label phase, where patients received valsartan 1 mg/kg/day for 4 weeks, and then optionally titrated to 2 mg/kg/day or up to 4 mg/kg/day. The primary endpoint was the change in MSBP from baseline at Week 6 during the double-blind phase. RESULTS Overall, 120 patients (94.5%) completed the study; 63 had CKD. A clinically and statistically significant reduction in MSBP from baseline to Week 6 was observed with the valsartan 4 mg/kg group compared with the valsartan 0.25 mg/kg group (8.5 vs 4.1 mmHg; p = .0157). A positive dose-response relationship for MSBP reduction was observed between the 0.25 mg/kg and 4 mg/kg groups (p = .0012). In the CKD subgroup, a significant reduction in MSBP was observed with 4 mg/kg (9.2 mmHg) versus 0.25 mg/kg (1.2 mmHg; p = .0096). In the non-CKD subgroup, a numerically greater decrease in MSBP was observed with 4 mg/kg (7.8 mmHg) versus 0.25 mg/kg (6.9 mmHg; p = .6531). Incidence of adverse events was lower with valsartan 4 mg/kg than 0.25 mg/kg (41.9% vs 51.6%) and similar between CKD and non-CKD subgroups (48.4% vs 45.3%) irrespective of dose. Increase in serum potassium (>20% compared to baseline) was observed more frequently in patients with CKD compared to non-CKD patients. CONCLUSION Valsartan was efficacious and well tolerated in children 1 to 5 years of age with hypertension, with or without CKD. Clinical trial registration: The study has been registered at ClinicalTrials.gov (Identifier: NCT01617681).
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Affiliation(s)
| | - Dorota Drozdz
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Białystok, Waszyngtona, Poland
| | | | - Robert Glazer
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Monique Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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14
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Dawson AE, Kallash M, Spencer JD, Wilson CS. The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care. Pediatr Nephrol 2021; 36:3869-3883. [PMID: 33890179 DOI: 10.1007/s00467-021-05077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.
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Affiliation(s)
- Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Mahmoud Kallash
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - John D Spencer
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA
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15
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Wu JGA, Tong A, Evangelidis N, Manera KE, Hanson CS, Baumgart A, Amir N, Sinha A, Dart A, Eddy AA, Guha C, Gipson DS, Bockenhauer D, Yap HK, Groothoff J, Zappitelli M, Alexander SI, Furth SL, Samuel S, Carter SA, Walker A, Kausman J, Martinez-Martin D, Gutman T, Craig JC. Patient and caregiver perspectives on blood pressure in children with chronic kidney disease. Nephrol Dial Transplant 2021; 37:1330-1339. [PMID: 34086937 DOI: 10.1093/ndt/gfab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over 50% of children with chronic kidney disease (CKD) have uncontrolled hypertension, increasing their long-term risk of cardiovascular disease and progression to kidney failure. Children receiving medications or dialysis may also experience acute blood pressure fluctuations accompanied by debilitating symptoms. We aimed to describe the perspectives of children with CKD and their parental caregivers on blood pressure, to inform patient-centered care. METHODS Secondary thematic analysis was conducted on qualitative data from the Standardized Outcomes in Nephrology-Children and Adolescents initiative, encompassing 16 focus groups, an international Delphi survey, and two consensus workshops. We analyzed responses from children with CKD (aged 8-21 years) and caregivers (of children aged 0-21 years) pertaining to blood pressure. RESULTS Overall, 120 patients and 250 caregivers from 22 countries participated. We identified five themes: invisibility and normalization (reassured by apparent normotension, absence of symptoms, expected links with CKD); confused by ambiguity (hypertension indistinguishable from cardiovascular disease, questioning need for prophylactic intervention, frustrated by inconsistent messages, struggling with technical skills in measurement); enabling monitoring and maintaining health (gauging wellbeing, preventing vascular complications); debilitating and constraining daily living (provoking anxiety and agitation, helpless and powerless, limiting life activities); and burden of medications (overwhelmed by quantity of tablets, distress from unexpected side effects). CONCLUSIONS For children with CKD and their caregivers, blood pressure was an important heath indicator, but uncertainty around its implications and treatment hampered management. Providing educational resources to track blood pressure, and minimizing symptoms and treatment burden, may improve outcomes in children with CKD.
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Affiliation(s)
- Justin Guang-Ao Wu
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Noa Amir
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Detlef Bockenhauer
- UCL Department of Renal Medicine and Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, Toronto, Canada
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine, at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Samuel
- Section of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon A Carter
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Department of Nephrology, and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda Walker
- Department of Nephrology, and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Nephrology, and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - David Martinez-Martin
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia.,The University of Sydney Nano Institute (Sydney Nano), The University of Sydney, Sydney, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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16
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DIAGNOSIS AND TREATMENT OF RENAL ARTERIAL HYPERTENSION IN PEDIATRIC PRACTICE. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-3-77-49-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Fu QY, Ma L, Li CC, He ZJ, Wang WH, Luo KF, Liu Y, Zhang ZH, Yang ZB, Tang HL, Yan JH. Hypertension/prehypertension and its determinants in pediatric IgA nephropathy. Medicine (Baltimore) 2020; 99:e22310. [PMID: 33019406 PMCID: PMC7535649 DOI: 10.1097/md.0000000000022310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin - a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the progression of pediatric IgAN remains unclear. We investigated the effects of HT/pre-HT on prognosis and its determinants as well as their correlation with clinicopathological parameters to identify more effective therapeutic targets.This single-center retrospective study compared clinicopathological features and treatment outcomes between patients with and without HT/pre-HT in 108 children with IgAN. Independent risk factors for HT/pre-HT were evaluated; segmental glomerulosclerosis was a significant variable, whose relationship with clinicopathological parameters was analyzed.Clinical outcomes of patients with and without HT/pre-HT differed considerably (P = .006) on ≥6 months follow-up. Patients with HT/pre-HT reached complete remission less frequently than those without HT/pre-HT (P = .014). Age, serum creatinine, prothrombin time, and segmental glomerulosclerosis or adhesion were independent risk factors for HT/pre-HT in pediatric IgAN (P = .012, P = .017, P = .002, and P = .016, respectively). Segmental glomerulosclerosis or adhesion was most closely associated with glomerular crescents (r = 0.456, P < .01), followed by Lees grades (r = 0.454, P < .01), renal arteriolar wall thickening (r = 0.337, P < .01), and endocapillary hypercellularity (r = 0.306, P = .001). The intensity of IgA deposits, an important marker of pathogenetic activity in IgAN, was significantly associated with the intensity and location of fibrinogen deposits (intensity: r = 0.291, P = .002; location: r = 0.275, P = .004).HT/pre-HT in pediatric IgAN patients is an important modifiable factor. A relationship is observed between HT/pre-HT and its determinants, especially segmental glomerulosclerosis. Potential therapeutic approaches for IgAN with HT/pre-HT might be directed toward the management of coagulation status, active lesions, and hemodynamics for slowing disease progression.
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18
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Bahrami N, Pahlavanzadeh S, Marofi M. Effect of a Supportive Training Program on Anxiety in Children with Chronic Kidney Problems and their Mothers' Caregiver Burden. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:193-199. [PMID: 31057635 PMCID: PMC6485030 DOI: 10.4103/ijnmr.ijnmr_88_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Chronic problems have a long course of treatment and are one of the important causes of the childhood hospitalization. The aim of this study was to determine the effect of a supportive training program on the children's anxiety and their mothers' caregiver burden. Materials and Methods This study was a randomized controlled clinical trial, performed on two groups in three stages in the autumn of 2017 on 112 individuals. The study population consisted of all children with chronic kidney problems who hospitalized in Emam Hossein Hospital (Isfahan, Iran) and their mothers. Sampling selection method was convenient. Participants were randomly assigned to experimental (n = 56) and control (n = 56) groups and the supportive training program, that was a self-regulating program, was done for the experimental group. The Face Anxiety Scale and the Zarit Caregiver Burden Scale were completed by both groups before, after and 1 month after the intervention. Statistical significance was set at 5%. Results There was a significant difference in the mean scores of anxiety and caregiver burden in the experimental group preintervention [anxiety: (t54= 0.31, p = 0.75); caregiver burden: (t54= 1.34, p = 0.18)], postintervention [anxiety: (t54= 5.30, p < 0.001); caregiver burden: (t54= 2.72, p = 0.009)], and follow-up [anxiety: (t54= 2.39, p = 0.01); caregiver burden: (t54= 3.06, p = 0.003)], whereas there was no significant difference in the mean scores of anxiety and caregiver burden in the control group. In order to controlling for pretest scores, the repeated measure analysis of covariance was adopted. Conclusions The results showed that the supportive training program can reduce children's anxiety and their mothers' caregiver burden and suggesting to nurses, an effective program to reduce the negative effects of hospitalization on children and their mothers.
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Affiliation(s)
- Niloofar Bahrami
- MSc of Pediatric Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Pahlavanzadeh
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Marofi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Lawrence J, Gwee A, Quinlan C. Pneumococcal haemolytic uraemic syndrome in the postvaccine era. Arch Dis Child 2018; 103:957-961. [PMID: 29674516 DOI: 10.1136/archdischild-2017-313923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/06/2018] [Accepted: 03/30/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Pneumococcal infection is a leading cause of haemolytic uraemic syndrome (HUS) and is potentially vaccine preventable. Published data suggest high mortality and poor renal outcomes. The introduction of the 7-valent pneumococcal conjugate vaccine (PCV) has seen the emergence of disease caused by non-vaccine strains, particularly 19A. We sought to describe serotype prevalence and outcomes, particularly after the introduction of the 13-valent PCV. DESIGN AND SETTING We performed a retrospective chart review, using hospital medical records to identify cases of HUS in a tertiary paediatric hospital in Australia over a 20-year period (January 1997-December 2016). Associated pneumococcal infection was identified, and serotype data were categorised according to vaccine era: prevaccine (January 1997-December 2004), PCV7 (January 2005-June 2011) and PCV13 (July 2011-December 2016). RESULTS We identified 66 cases of HUS. Pneumococcal infection was proven in 11 cases, representing 4% (1/26) of cases prior to the introduction of PCV7, 20% (3/15) in the PCV7 era and 28% (7/25) in the PCV13 era. Subtype 19A was the most prevalent pneumococcal serotype (6/11). All four patients who received PCV7 were infected with a non-vaccine serotype. Four of the five patients who received PCV13 were classed as vaccine failures. Median follow-up was 14 (range 1-108) months. Chronic kidney disease was the most common complication (4/7). We observed no mortality, neurological sequelae or progression to end-stage kidney disease. CONCLUSIONS Serotype 19A is most commonly associated with pneumococcal HUS, despite the introduction of the 13-valent vaccine. Chronic kidney disease is a significant complication of pneumococcal HUS.
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Affiliation(s)
- Jolie Lawrence
- Department of Nephrology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Kidney Development, Disease and Regeneration, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine Quinlan
- Department of Nephrology, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Kidney Development, Disease and Regeneration, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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20
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Evaluation of Blood Pressure in Children with Hydronephrosis in Comparison with Healthy Children. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.68998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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21
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Prevalence of Primary Hypertension and Risk Factors in Grade XII Learners in KwaZulu-Natal, South Africa. Int J Hypertens 2018; 2018:3848591. [PMID: 30057806 PMCID: PMC6051133 DOI: 10.1155/2018/3848591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 12/30/2022] Open
Abstract
Hypertension in childhood leads to hypertension in adult life, the strongest risk factor being obesity. This study determined the prevalence of primary hypertension and its risk factors in Grade XII learners in KwaZulu-Natal, South Africa, from March 2016 to June 2017. Weight, height, body mass index (BMI), random finger prick cholesterol and glucose, and spot urine for an albumin : creatinine ratio were measured. An average of three separate blood pressure readings taken was at least 5 minutes apart. Five hundred and sixty-four learners had weight, height, and BMI; 536 had random blood glucose; and 545 had cholesterol and random spot urine albumin : creatinine ratios measured. Prehypertension was detected in 168 (29.7%) and hypertension in 77 (13.7%) of learners. Ninety (15.9%) were overweight and 75 (13,3%) were obese. Hypercholesterolaemia was present in 58 (10.8%) and a high spot random urine albumin : creatinine ratio in 5 (1.0%). None had a high blood glucose level. Both prehypertension and hypertension in all learners showed a significant increase with increasing BMI. Six (1.0%) learners had metabolic syndrome. Female learners in other racial groups (defined as Indian, mixed race, and White learners), overweight, and obese learners showed significantly higher rates of hypercholesterolaemia. We showed overweight and obesity as risk factors for prehypertension and hypertension. This presages the need for an appropriate diet and adequate exercise in a child's school career.
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22
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Tang W, Chen Q, Chen L, Chen S, Shao X, Wang X. FAVORABLE EFFECT OF LEVOTHYROXINE ON NUTRITIONAL STATUS OF PATIENTS WITH STAGE 3-4 CHRONIC KIDNEY DISEASE. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:338-345. [PMID: 31149281 PMCID: PMC6525772 DOI: 10.4183/aeb.2018.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to analyze the incidence of malnutrition in patients with stage 3-4 chronic kidney disease (CKD) and primary subclinical hypothyroidism and the effect of levothyroxine for improving nutritional status and delaying kidney disease. PATIENTS AND METHODS In the study were included 200 patients with stage 3-4 CKD: CKD3 stage group (n=100) and CKD4 stage group (n=100). These patients were further divided into: control group (non-treatment group) group a (n=65) and experiment group (treatment group) group b (n=135) according to their levothyroxine treatment. The CKD3 stage group is divided into c3 (n=35) and e3 (n=65), and CKD4 group is divided into c4 (n=30) and e4 (n=70) groups. RESULTS Upon treatment of subclinical hypothyroidism with levothyroxine, nutritional indicators of patients are improved, and the weight, left and right-hand grip strength, hemoglobin (HB), serum albumin are higher compared to control. After levothyroxine treatment, eGFR in the treatment group increased with each time point, while in the control group it could be seen a significant decrease. This effect was more robust in the CKD3 group than in the CKD4 group. In conclusion, levothyroxine treatment can delay the progression of kidney diseases with more efficacy in stage 3 patients.
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Affiliation(s)
- W. Tang
- The First People’s Hospital of Fuyang - Intensive care unit, Hangzhou, Zhejiang, China
| | - Q. Chen
- The First People’s Hospital of Fuyang - Intensive care unit, Hangzhou, Zhejiang, China
| | - L. Chen
- The First People’s Hospital of Fuyang - Intensive care unit, Hangzhou, Zhejiang, China
| | - S. Chen
- The First People’s Hospital of Fuyang - Intensive care unit, Hangzhou, Zhejiang, China
| | - X. Shao
- The First People’s Hospital of Fuyang - Intensive care unit, Hangzhou, Zhejiang, China
| | - X. Wang
- The First People’s Hospital of Fuyang - Intensive care unit, Hangzhou, Zhejiang, China
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Abstract
PURPOSE OF REVIEW Hypertension is an independent risk factor for progression of chronic kidney disease (CKD) in children. Children with early CKD develop hypertension secondary to renal disease. This review aims to highlight recent advances that help us better understand the current role of hypertension in progression of CKD in children. RECENT FINDINGS There is increasing evidence that children with CKD who have hypertension develop early atherosclerosis and cardiac adaptive changes. Emerging data from pediatric research in CKD show that elevated blood pressure is associated with the presence of abnormal subclinical markers of cardiovascular disease including increased carotid intima-media thickness, pulse wave velocity and left ventricular mass index. There is also some evidence that these early cardiovascular changes are reversible. Twenty-four hour ambulatory blood pressure monitoring (ABPM) is recommended in children with CKD by the American Academy of Pediatrics to diagnose hypertension. SUMMARY Hypertension is associated with subclinical cardiovascular disease in children with CKD. Early diagnosis of hypertension by ABPM and identification of subclinical cardiovascular changes provide a window for intervention, which may reverse early cardiovascular disease, thereby delaying dialysis and improving cardiovascular morbidity and mortality.
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