Department of Pediatrics, Seattle Children's Hospital, Seattle, WA 98105, USA.
J Pediatr. 2012 Apr;160(4):621-625.e1. doi: 10.1016/j.jpeds.2011.09.046. Epub 2011 Nov 5.
To evaluate and characterize the degree of blood pressure (BP) control in children on chronic dialysis and to identify significant predictors of hypertension and BP control in these patients.
Linear and logistic regression models were used to examine trends in BP and BP control in a cross-sectional sample of patients on chronic dialysis aged 1-21 years enrolled in the North American Pediatric Renal Trials and Collaborative Studies registry from 1992-2008.
At 6 months after dialysis initiation, 67.9% of patients had uncontrolled or untreated hypertension, and 57.8% were prescribed antihypertensive medications. More recent year of dialysis initiation was associated with a higher use of antihypertensive medication and lower systolic BP and diastolic BP z scores (P < .001) measured over time from 6 months to 3 years post dialysis initiation. Other factors associated with higher BP included black race, glomerular disease, younger age, hemodialysis (systolic BP only), and antihypertensive use. There were significant differences in BP control by dialysis modality and disease etiology, with patients on hemodialysis or those with glomerular diseases having the highest percentage of uncontrolled hypertension.
Despite widespread antihypertensive use, many pediatric patients on dialysis are at risk for untreated or uncontrolled hypertension. Additional efforts are needed to improve management of hypertension in these children.
评估和描述慢性透析儿童的血压（BP）控制程度，并确定这些患者高血压和 BP 控制的显著预测因素。
线性和逻辑回归模型用于检查 1992 年至 2008 年期间在北美儿科肾脏试验和协作研究登记处登记的年龄在 1-21 岁的慢性透析患者的横断面样本中 BP 和 BP 控制的趋势。
在透析开始后 6 个月，67.9%的患者患有未控制或未经治疗的高血压，57.8%的患者开了降压药。最近开始透析的年份与更频繁地使用降压药以及更低的收缩压和舒张压 z 评分（P <.001）相关，这些数据是从透析开始后 6 个月到 3 年的时间内测量的。其他与更高 BP 相关的因素包括黑种人、肾小球疾病、年龄较小、血液透析（仅收缩压）和使用降压药。不同的透析方式和疾病病因对 BP 控制的影响存在显著差异，血液透析患者或肾小球疾病患者的未控制高血压比例最高。
尽管广泛使用降压药，但许多接受透析的儿科患者仍面临未治疗或未控制的高血压风险。需要进一步努力改善这些儿童的高血压管理。
