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Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry

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Abstract

Background

High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated.

Methods

This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant.

Results

At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP z-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP z-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected.

Conclusions

BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls).

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Funding

This study has been made possible by grants of the German Ministry of Education and Research (reference numbers 01EO0802 and 01EO1302) and of the Ministry of Science and Culture of Lower Saxony (reference Geschlecht-Macht-Wissen). We gratefully acknowledge the funding of the CERTAIN Registry by grants from the Dietmar Hopp Stiftung and the pharmaceutical companies Astellas and Novartis.

Author information

Authors and Affiliations

  1. Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Rizky I. Sugianto, Nima Memaran & Anette Melk

  2. Department of Nephrology, Hannover Medical School, Hannover, Germany

    Bernhard M. W. Schmidt

  3. Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ali Duzova & Rezan Topaloglu

  4. Department of Pediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

    Tomas Seeman

  5. Department of General Pediatrics, University Hospital Muenster, Muenster, Germany

    Sabine König

  6. Renal Transplant Clinic, Bambino Gesu Children’s Hospital IRCCS, Rome, Italy

    Luca Dello Strologo

  7. Pediatric Nephrology, Dialysis and Transplant Unit, Hospital University Padua, Padua, Italy

    Luisa Murer

  8. Division of Pediatric Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey

    Zeynep Birsin Özçakar

  9. Olga Children’s Hospital, Clinic of Stuttgart, Stuttgart, Germany

    Martin Bald

  10. Royal Manchester Hospital, Manchester, UK

    Mohan Shenoy

  11. Center for Children and Adolescent, Pediatric Clinic II, University of Duisburg-Essen, Essen, Germany

    Anja Buescher & Peter F. Hoyer

  12. KfH Kidney Centre for Children and Adolescents, St. Georg Hospital, Leipzig, Germany

    Michael Pohl

  13. Department of General Pediatrics, University of Tuebingen, Tuebingen, Germany

    Heiko Billing

  14. Division of Pediatric Nephrology and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jun Oh

  15. University Children’s Hospital Rostock, Rostock, Germany

    Hagen Staude

  16. Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Martin Pohl

  17. Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

    Gurkan Genc

  18. KfH Kidney Centre for Children and Adolescents, University Hospital Giessen-Marburg, Marburg, Germany

    Günter Klaus

  19. Department of Pediatric Nephrology, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey

    Caner Alparslan

  20. The Children’s Memorial Health Institute, Warsaw, Poland

    Ryszard Grenda & Jacek Rubik

  21. Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany

    Kai Krupka, Burkhard Tönshoff & Elke Wühl

Authors
  1. Rizky I. Sugianto
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  2. Bernhard M. W. Schmidt
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  3. Nima Memaran
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  4. Ali Duzova
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  5. Rezan Topaloglu
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  6. Tomas Seeman
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  7. Sabine König
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  8. Luca Dello Strologo
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  9. Luisa Murer
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  10. Zeynep Birsin Özçakar
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  11. Martin Bald
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  12. Mohan Shenoy
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  13. Anja Buescher
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  14. Peter F. Hoyer
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  15. Michael Pohl
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  17. Jun Oh
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  18. Hagen Staude
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  19. Martin Pohl
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  20. Gurkan Genc
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  21. Günter Klaus
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  22. Caner Alparslan
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  23. Ryszard Grenda
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  24. Jacek Rubik
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  25. Kai Krupka
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  26. Burkhard Tönshoff
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  27. Elke Wühl
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  28. Anette Melk
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Corresponding author

Correspondence to Anette Melk.

Ethics declarations

The registry’s data privacy and policy concept was approved by the Ethics Committee of the University of Heidelberg and each contributing center and fully complies with the declaration of Helsinki.

Conflict of interest

Burkhard Tönshoff received research and travel grants, lecture fees, and participated in advisory boards of Astellas, Bristol-Myers Squibb, Novartis, and Roche.

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Sugianto, R.I., Schmidt, B.M.W., Memaran, N. et al. Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry. Pediatr Nephrol 35, 415–426 (2020). https://doi.org/10.1007/s00467-019-04395-4

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  • DOI: https://doi.org/10.1007/s00467-019-04395-4

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