ESPN 51th Annual Meeting

ESPN 2018


 
ARTERIAL HYPERTENSION IS PREVALENT IN PEDIATRIC HEMODIALYSIS AND RELATED TO DIALYSATE SODIUM CONCENTRATION AND WEEKLY DIALYSIS TIME – DATA FROM THE INTERNATIONAL PEDIATRIC HEMODIALYSIS NETWORK (IPHN)
Dagmara Borzych-Duzalka 1 Rukshana Shroff 2 Sevcan Bakkaloglu 3 Cezary Prokurat 4 Gunter Klaus 5 Charlotte Samaille 6 Saoussen Krid 7 Divna Kruscic 8 Dorota Drozdz 9 Tim Ulinski 10 Onder Yavascan 11 Sevgi Mir 12 Christopher Reid 13 Enrico Vidal 14 Heiko Billing 15 Nikoleta Printza 16 Sandra Habbig 17 Bradley A Warady 18 Franz Schaefer 19 Claus Peter Schmitt 19

1- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
2- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
3- Gazi University Hospital, Ankara, Turkey
4- Childrens Memorial Health Institute, Warsaw, Poland
5- Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany
6- Service de Néphrologie Pédiatrique, Hôpital Jeanne De Flandre, Lille, France
7- Hôpital Necker-Enfants Malades, Paris, France
8- University Childrens Hospital, Belgrade, Serbia
9- Jagiellonian University Medical College, Krakow, Poland
10- Armand Trousseau Hospital, Paris, France
11- Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey
12- Ege University Faculty of Medicine, Izmir, Turkey
13- Evelina Childrens Hospital, London, United Kingdom
14- Pediatric Nephrology, Dialysis and Transplant Unit, Padova, Italy
15- Childrens University Hospital, Tuebingen, Germany
16- Aristoteles University, Thessaloniki, Greece
17- University Hospital Cologne, Cologne, Germany
18- Childrens Mercy Hospital, Kansas City, USA
19- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
 
Introduction:

Fluid and salt overload in dialysis patients result in arterial hypertension and are associated with poor outcome. Hemodialysis machines allow for individualized fluid and salt removal, however, the adequate dialysate sodium (dNa) concentration  remains controversial. High dNa increases interdialytic weight gain (IDWG) and blood pressure, low dNa the risk of intradialytic hypotension and cramps.

 

Material and methods:

IPHN prospectively monitors pediatric HD patients from 81 pediatric centers in 36 countries. To assess HD vs. HDF modality, blood pressure, dNa and IDWG interaction, and dialysis tolerance we analyzed data of 662 patients, age 0-20 years, on chronic HD(F).

Results:

Weekly dialysis time was 12 (2-18 hours), dialysis frequency 1-6 per week.  41%/23% of patients had increased systolic/diastolic blood pressure, 62% were on 2.2±1.1 (1-6) antihypertensives.  In 1830 available 6-monthly observations mean dNa was 138 (range: 130-145) mmol/l, with highest prevalence of 138 (39%) and 140mmol/l (29%). dNa correlated with diastolic BP-SDS (r=0.09, p=0.0003) and IDWG (r=0.19, p<0.0001), but not with systolic BP-SDS. In non-anuric patients dNa correlated with urine output/bsa (r=0.12, p=0.01). Hypotensive episodes were reported in 25% of patients (1-20 per month) independent of dNa, but dependent on IDWG (p<0.0001). In multivariate linear regression analysis diastolic BP-SDS was independently predicted by dNa (p=0.005), IDWG, younger age, number of antihypertensives (all p<0.0001) and weekly dialysis time (p=0.003), but not by dialysis modality. IDWG was independently predicted by dNa, low urine output/bsa , HD versus HDF modality (all p<0.0001), weekly dialysis time (p=0.001), and dialysis frequency (p=0.02). Similar findings were obtained when limiting analysis to the 421 patients on thrice weekly HD for 10-14 hours weekly.

 

Conclusions:

Arterial hypertension is prevalent in children on hemodialysis, despite intensive pharmacological treatment. High diastolic blood pressure should be prevented by stepwise lowering of DNa without increasing the risk of intradialytic hypotension and cramps and/or prolonged hemodialysis time.