Blood Pressure Control in Adolescents With CKD and Risk of Kidney Failure in Young Adulthood
Year: 2026
Type: article
Study design: Observational Study
Abstract: Rationale & Objective Understanding risk factors for chronic kidney disease (CKD) progression during adolescence is essential to improve outcomes for these individuals as adults. The objective of the current study was to retrospectively analyze electronic health records (EHR) of children with CKD to understand the effect of cumulative systolic blood pressure (SBP) load during adolescence on time to kidney replacement therapy or death during young adulthood. Study Design Retrospective cohort study Setting & Participants Adolescents with chronic kidney disease were enrolled from 14 academic medical centers in the Preserving Kidney Function in Children with Chronic Kidney Disease (PRESERVE) study. Individuals between the ages of 1 and <18 years with ≥2 eGFRs between 30 and <90 mL/min/1.73m 2 separated by ≥90 days without an intervening eGFR value ≥90 mL/min/1.73m 2 were included. Exposure Cumulative systolic blood pressure (SBP) load was defined using area under and above the SBP curve (i.e., time and magnitude), and time-only approaches using the 50th, 75th, and 90th SBP percentiles. Outcomes Time to kidney replacement therapy (KRT, chronic dialysis initiation or kidney transplantation) or death were ascertained via linkage with the United States Renal Data System. Analytical Approach Cox proportional hazards models were used to investigate the relationship between BP control and the composite of KRT or death. Results The cohort included 2,585 individuals with a median follow-up of 7.45 years (IQR: 6.05-9.20), among whom 4.6% (n=118) met the KRT or death outcome between ages 18-30 years. In an adjusted Cox model, each unit increase (pp*time) in cumulative SBP load above the 90th percentile was associated with 1.36 (95% CI: 1.17, 1.58) times higher hazards of KRT or death between ages 18-19 years. SBP control to <90th percentile for 25%, 50%, and 100% of time between ages 14 to 18 years was associated with a 47%, 72%, and 92% risk reduction of KRT or death between ages 18 to 19 years compared to no SBP control. Limitations Misclassification of BP control related to white coat or masked hypertension. Adherence to prescribed anti-hypertensive medications was not assessed. Conclusions Worse SBP control during adolescence was associated with a markedly increased risk of kidney failure in young adulthood. Cumulative SBP load derived from EHR data can inform risk of adverse long-term kidney outcomes. Plain-Language Summary Chronic kidney disease is commonly accompanied by elevated blood pressure. Understanding risk factors for chronic kidney disease progression during adolescence is essential to improve outcomes for these individuals as adults. We used electronic health records to study the effect of systolic blood pressure load in adolescents with chronic kidney disease on risk of kidney failure in young adulthood. We found that worse systolic blood pressure control during adolescence is associated with a markedly increased risk of kidney failure in young adulthood. The study demonstrates that blood pressure readings from electronic health record data can be used to estimate the risk of adverse long-term kidney outcomes.
Source: Kidney Medicine
Authors: Dorey A. Glenn, Morgan Botdorf, Andrea Allen, Kimberley Dickinson, Kaleigh Wieand, Amy Goodwin Davies, Victoria Besser, Bradley P. Dixon, Caroline Gluck, John Hammond, Lyndsay Harshman, Mahmoud Kallash, Chryso Katsoufis, Sara Kibrom, Alexander Kula, Mark Mitsnefes, Yosuke Miyashita, Zubin Modi, Larry Patterson, Michelle R. Denburg, Christopher B. Forrest, Jarcy Zee
Institutions: University of North Carolina at Chapel Hill, Children's Hospital of Philadelphia, Medical College of Wisconsin, University of Colorado Anschutz, University of Colorado Denver, Nemours Children's Health System, Johns Hopkins University, University of Iowa Stead Family Children’s Hospital, Nationwide Children's Hospital, University of Miami, Stanford Medicine, Stanford University, Lurie Children's Hospital, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Seattle Children's Hospital, University of Washington, University of Michigan, Michigan Medicine, UF Health Shands Hospital, University of Florida, University of Pennsylvania
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,590
OpenAlex ID: W7160277903