Epidemiology and management of hypertension in paediatric and young adult kidney transplant recipients in The Netherlands.
Hypertension in kidney transplant recipients (KTRs) is a risk factor for cardiovascular mortality and graft loss. Data on the prevalence of hypertension and uncontrolled hypertension (uHT) in paediatric and young adult KTRs are scarce. Also, it is unknown whether 'transition' (the transfer from paediatric to adult care) influences control of hypertension. We assessed the prevalence of hypertension and uHT among Dutch paediatric and young adult KTRs and analysed the effects of transition. Additionally, we made an inventory of variations in treatment policies in Dutch transplant centres.



Cross-sectional and longitudinal national data from living KTRs ≤30 years of age (≥1-year post-transplant, eGFR >20 mL/min) were extracted from the 'RICH Q' database, which comprises information about all Dutch KTRs <19 years of age, and the Netherlands Organ Transplant Registry database for adult KTRs (≥18-30 years of age). We used both upper-limit blood pressure (BP) thresholds for treatment according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. uHT was defined as a BP above the threshold. A questionnaire on treatment policies was sent to paediatric and adult nephrologists at eight Dutch transplant centres.



Hypertension and uHT were more prevalent in young adult KTRs (86.4 and 75.8%) than in paediatric KTRs (62.7 and 38.3%) according to the KDIGO definition. Time after transplantation was comparable between these groups. Longitudinal analysis showed no evidence of effect of transition on systolic BP or prevalence of uHT. Policies vary considerably between and within centres on the definition of hypertension, BP measurement and antihypertensive treatment.



Average BP in KTRs increases continuously with age between 6 and 30 years. Young adult KTRs have significantly more uHT than paediatric KTRs according to KDIGO guidelines. Transition does not influence the prevalence of uHT.
Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
Linn C
LC
Dobrowolski
Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, Room H7-232 Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Maike
M
van Huis
Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
Johanna H
JH
van der Lee
Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
Hessel
H
Peters Sengers
Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Marc R
MR
Liliën
Department of Pediatric Nephrology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.
Karlien
K
Cransberg
Department of Pediatric Nephrology, St Radboud University Medical Center, Nijmegen, The Netherlands.
Marlies
M
Cornelissen
Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, Room H7-232 Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Antonia H
AH
Bouts
Department of Internal Medicine: Nephrology and Kidney Transplantation, Leiden University Medical Center, Leiden, The Netherlands.
Johan W
JW
de Fijter
Department of Internal Medicine: Nephrology and Kidney Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Stefan P
SP
Berger
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Arjan
A
van Zuilen
Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Shaikh A
SA
Nurmohamed
Department of Internal Medicine: Nephrology and Kidney Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Michiel H G
MH
Betjes
Department of Internal Medicine: Nephrology and Kidney Transplantation, St Radboud University Medical Center, Nijmegen, The Netherlands.
Luuk
L
Hilbrands
Netherlands Organ Transplant Registry, Leiden, The Netherlands.
Andries J
AJ
Hoitsma
Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
Frederike J
FJ
Bemelman
Department of Internal Medicine: Nephrology and Kidney Transplantation, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
C T Paul
CTP
Krediet
Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center at the University of Amsterdam, Room H7-232 Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Jaap W
JW
Groothoff
D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D060305:Transition to Adult Care; D066027:Transplant Recipients; D055815:Young Adult
D000959:Antihypertensive Agents
antihypertensive treatment; blood pressure; hypertension; kidney transplantation; paediatrics