ESPN 51th Annual Meeting

ESPN 2018


 
High blood pressure in children with end-stage chronic kidney disease: Hemodialysis versus peritoneal dialysis
HAMMI YOUSRA 1 SAYARI TAHA 1 FERJANI MARYEM 1 BOUSSETTA ABIR 1 JELLOULI MANEL 1 GARGAH TAHER 1

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, CHARLES NICOLLE HOSPITAL, TUNIS, TUNISIA
 
Introduction:

Classically high blood pressure (HBP) is a widespread phenomenon among patients with end-stage chronic kidney disease (ESCKD), found in 70%. In this study we support the epidemiological and clinical details according to the chosen dialysis modality by hemodialysis or peritoneal dialysis.

Material and methods:

A retrospective descriptive study in the pediatric ward of Charles Nicolle Hospital over a period of 15 years (January 1998, December 2013) and concerning any patient with ESCKD presenting a HBP.

Results:

Of the 168 patients with ESCKD, 58 had HBP (34.5%). Patients had an average age of 13.8 years, and their sex ratio was 1.32. Renal failure was discovered at an average age of 11.3 years, with a progression to the end-stage at the age of 13.6 years. The initially chosen technique of dialysis was hemodialysis (HD) in 23%, peritoneal dialysis (PD) in 77%. The etiology of renal failure was related to uropathies (31%), followed by glomerulonephritis (15.5%). Hypertension was predominantly systolic and found to be either initially related to the underlying pathology in 57% or discovered secondarily during the impact assessment (31%) or following a complication (11.6%). The anti-hypertensive treatment was a monotherapy (27%), reaching a quadritherapy (1.8%) and even nephrectomy for non-controlled HBP (2.4%). The blood pressure profiles after dialysis onset were tributary of the selected method ; all patients undergoing PD still have HBP contrasting with those undergoing HD who had improved their blood pressure tendency in (14%), or had normalization and even hypotension (15%). Worsening of hypertension was observed only in 3 patients undergoing HD.

Conclusions:

HBP among children with ESCKD is frequent or even inevitable, its pharmacological control is difficult and remains non-consensual. The switch to HD appears to be an effective solution to balance it and minimize complications.