Hypertension in autosomal dominant polycystic kidney disease: a meta-analysis.
BACKGROUND
Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that can cause hypertension during childhood, but the true prevalence of hypertension during childhood is not known.


OBJECTIVE
We undertook a systematic review and meta-analysis to determine the prevalence of hypertension in children with ADPKD.


METHODS
Systematic review of articles published between 1980 and 2015 in MEDLINE and EMBASE.


METHODS
Studies selected by two authors independently if reporting data on prevalence of hypertension in children and young persons aged <21 years with a diagnosis of ADPKD. Observational series were included with study populations of >15 children. Articles were excluded if inadequate diagnostic criteria for hypertension were used. Studies with selection bias were included but analysed separately.


METHODS
Data extracted on prevalence of hypertension, proteinuria and reduced renal function using standardised form. Meta-analysis was performed to calculate weighted mean prevalence.


RESULTS
903 articles were retrieved from our search; 14 studies met the inclusion criteria: 1 prospective randomised controlled trial; 8 prospective observational studies; and 5 retrospective cross-sectional studies. From 928 children with clinically confirmed ADPKD, 20% (95% CI 15% to 27%) were hypertensive. The estimated prevalence of proteinuria in children with ADPKD is 20% (8 studies; 95% CI 9% to 40%) while reduced renal function occurred in 8% (5 studies; 95% CI 2% to 26%).


CONCLUSIONS
Studies showed a high degree of methodological heterogeneity (I2=73.4%, τ2=0.3408, p<0.0001). Most studies did not use ambulatory blood pressure (BP) monitoring to diagnose hypertension.


CONCLUSIONS
In this meta-analysis we estimate 20% of children with ADPKD have hypertension. In the population, many children with ADPKD are not under regular follow-up and remain undiagnosed. We recommend that all children at risk of ADPKD have regular BP measurement.
Institute of Child Health, University College London, London, UK.
Matko
M
Marlais
Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Oliver
O
Cuthell
Institute of Child Health, University College London, London, UK.
Dean
D
Langan
Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Jan
J
Dudley
Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK.
Manish D
MD
Sinha
Institute of Child Health, University College London, London, UK.
Paul J D
PJ
Winyard
D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology* / Q000503:physiopathology; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000503:physiopathology; D015995:Prevalence; D011507:Proteinuria / Q000209:etiology / Q000503:physiopathology
Nephrology; Paediatric Practice