Effect of hypertension and antihypertensive medications on residual renal function in children treated with chronic peritoneal dialysis

Abstract Purpose To evaluate the effect of hypertension (HTN) and antihypertensive medications (AHM) on residual renal function (RRF) in children on CAPD and APD. Material/methods We retrospectively evaluated underlying kidney disease, systolic and diastolic blood pressure (SBP/DBP), presence and control of HTN (SBP/DBP ≥ 95th percentile), AHM, RRF (daily diuresis, residual glomerular filtration rate [rGFR]), biochemical parameters, BMI Z -score, and dialysis parameters during 12-month follow-up in 87 children (38 CAPD, 49 APD) aged 10.22 ± 4.31 years. The rate of RRF loss was expressed as absolute and relative [%] reduction. Results At baseline, HTN was found in 74.7% patients (CAPD/APD: 84.2%/67.3%, P  = 0.06), most commonly in HUS and least frequently in CAKUT. The proportion of CAPD/APD patients with poorly controlled HTN was 70.0%/63.3% ( P  = 0.50). Relative daily diuresis loss in children with uncontrolled HTN was higher ( P  = 0.017) compared to children with SBP/DBP β  = −0.30, P β  = −0.31, P  = 0.004); absolute rGFR loss to baseline rGFR ( β  = −0.73, P β  = −0.36, P  = 0.02); relative daily diuresis loss to mean BMI Z -score ( β  = −0.44, P  = 0.04); and relative rGFR to baseline rGFR ( β  = −0.37, P β  = −0.21, P  = 0.045). Conclusions 1. Maintaining blood pressure 2. Risk factors for rapid RRF loss in children on CAPD/APD include elevated SBP, high baseline diuresis/rGFR, proteinuria, and high glucose load in the dialysis fluid.