Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, NC, USA.
Division of Critical Care Medicine, Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC, USA.
Pediatr Nephrol. 2024 May;39(5):1599-1605. doi: 10.1007/s00467-023-06222-3. Epub 2023 Nov 21.
Acute kidney injury (AKI) is common in hospitalized children and increases the risk of chronic kidney disease (CKD) and hypertension, but little is known about the patient level risk factors for pediatric hypertension after AKI. The aims of this study are to evaluate the prevalence and risk factors for new onset hypertension in hospitalized children with AKI and to better understand the role of acute kidney disease (AKD) in the development of hypertension.
This study was an observational cohort of all children ≤ 18 years old admitted to a single tertiary care children's hospital from 2015 to 2019 with a diagnosis of AKI. Hypertension was defined as blood pressure > 95th percentile for sex, age, height, diagnosis of hypertension on the problem list, or prescription of antihypertensive medication for > 90 days after AKI.
A total of 410 children were included in the cohort. Of these, 78 (19%) developed hypertension > 90 days after AKI. A multivariable logistic regression model identified AKD, need for kidney replacement therapy, congenital heart disease, and non-kidney solid organ transplantation as risk factors for hypertension after AKI.
Incident hypertension after 3 months is common among hospitalized children with AKI, and AKD, need for dialysis, congenital heart disease, and non-kidney solid organ transplant are significant risk factors for hypertension after AKI. Monitoring for hypertension development in these high-risk children is critical to mitigate long-term adverse kidney and cardiovascular outcomes.
急性肾损伤（AKI）在住院儿童中很常见，会增加慢性肾脏病（CKD）和高血压的风险，但对于 AKI 后儿科高血压的患者水平危险因素知之甚少。本研究旨在评估 AKI 住院儿童新发高血压的患病率和危险因素，并更好地了解急性肾疾病（AKD）在高血压发展中的作用。
本研究是对 2015 年至 2019 年期间在一家三级儿童保健医院住院的所有年龄≤18 岁的 AKI 诊断患儿进行的观察性队列研究。高血压定义为血压性别、年龄、身高第 95 百分位以上、问题列表中诊断为高血压或 AKI 后≥90 天服用降压药物。
共纳入 410 例患儿，其中 78 例（19%）在 AKI 后 90 天以上发生高血压。多变量逻辑回归模型确定 AKD、需要肾脏替代治疗、先天性心脏病和非肾脏实体器官移植是 AKI 后高血压的危险因素。
AKI 住院患儿 3 个月后发生高血压的情况较为常见，AKD、透析需求、先天性心脏病和非肾脏实体器官移植是 AKI 后高血压的重要危险因素。对这些高危儿童进行高血压发展的监测对于减轻长期不良肾脏和心血管结局至关重要。
