Introduction The burden of chronic kidney disease (CKD) includes comorbidities such as anemia (AN) and hypertension (HTN). According to current guidelines, renal transplant (RTx) recipients are considered members of the CKD population irrespective of renal function. The purpose of this study was to compare the prevalence, associations with, and management of AN and HTN in pediatric RTx and CKD patients.
Methods This retrospective, cross-sectional cohort study included RTx patients (n=45) and CKD patients (n=102) at BC's Children's Hospital from 2000 to 2003. CKD stage was based on a nuclear medicine glomerular filtration rate (GFR). Relevant labs and clinic reports were collected on the day of nGFR, including drug therapy (initiation of therapy within three months of AN or HTN defined appropriate therapy). Multivariate logistic regression was used to examine the associations between transplant status (vs. CKD status) and outcomes of interest accounting for CKD stages (Stage 3 to 5 vs. 1 to 2) and adjusting for age, gender, ethnicity, body surface area, and primary diagnosis; and utilizing the current recommendations for pediatric CKD management as the gold standard for management.
Results Anemia - In the multivariate model, the risk of AN is higher in RTx compared to non-transplant CKD [OR 9.43 (95% CI 3.77-23.58), p < 0.01)] for all CKD stages. Among all patients, those with CKD Stage 3 to 5 are at higher risk of AN compared to CKD Stage 1 to 2 [OR 2.92 (95% CI 1.31-6.50), p < 0.01]. Hypertension - The risk of HTN is greater in higher CKD stages for CKD patients [OR 4.76 (95% CI 1.98-11.41), p < 0.01], and remains the same for RTx patients [OR 0.72 (95% CI 0.18-2.98), p=0.65]. Also, the risk of HTN was significantly higher in RTx compared to non-transplant CKD for patients with CKD Stage 1 to 2 [OR 11.9 (95% CI 3.2-43.7), p < 0.01], but not for patients with CKD Stage 3 to 5 [OR 1.81 (95% CI 0.6-5.1), p=0.26].
Conclusions As expected, higher stages of CKD are associated with a statistically significant increased likelihood of both AN and HTN. However, even after controlling for age, gender, ethnicity, and primary diagnosis, pediatric RTx are at a higher risk for AN and HTN. This data suggests that more efforts need to be directed to the assessment and appropriate management of both anemia and hypertension in the pediatric renal transplant patient.
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