Introduction: Hypertension is a common occurrence amongst paediatric kidney transplant recipients, contributing to graft dysfunction and long-term cardiovascular morbidity and mortality. Risk factors for developing hypertension in children with a kidney transplant include deceased-donor recipients, high body-mass-index (BMI), use of immunosuppressive medications such as steroids and calcineurin inhibitors, graft dysfunction and recurrence of renal disease. Our study aimed to describe the prevalence and management of hypertension post-kidney transplant in children and identify risk factors for the development of hypertension at 12 months post-transplant.
Methods: A single-centre retrospective cohort study was conducted in a tertiary children’s hospital in New South Wales, Australia. Paediatric kidney transplant recipients between the years of 2007 and 2021 were included in this study. Hypertension was defined as having clinic BP > 95th centile on single visit, receiving an antihypertensive medication or both. Logistic regression models were used to assess the association between demographic characteristics and the development of hypertension at 12 months.
Results: 52 participants were included in this study, of which 20 (38%) were female. The mean age was 7 (SD 4.1) years. 31 participants (59%) were hypertensive at time of transplant. The number of those who were hypertensive was 35 (65%) at 1 month, 33 (64%) at 3 months, 28 (54%) at 6 months, 29 (56%) at 1 year and 30 (58%) at 3 years and 23 (45%) at 5 years. The most commonly prescribed anti-hypertensive at all time-points was calcium-channel blockers (CCB). Being overweight (OR 2.36 95% CI 0.58 to 9.56) or obese (OR 10.2 95% CI 1.75 to 59.7) at 12 months was a statistically significant risk factor associated with hypertension at 12 months post-transplant (p <0.05).
Conclusion: Our paediatric kidney transplant recipient population demonstrated a high prevalence of hypertension. CCB was the preferred choice of anti-hypertensive medication for the management of blood pressure. A BMI that was above a healthy range was strongly associated with hypertension at 12 months post-transplant.