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NDT Advance Access published online on November 22, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi280
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© The Author 2005. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org
Received August 25, 2005
Accepted October 28, 2005

Original Article

Hypertension in dialysed children: the prevalence and therapeutic approach in Poland--a nationwide survey

Marcin Tkaczyk 1 *, Michal Nowicki 1, Irena Balasz-Chmielewska 2, Hanna Boguszewska-Baczkowska 3, Dorota Drozdz 4, Barbara Kollataj 5, Tomasz Jarmolinski 6, Katarzyna Jobs 3, Katarzyna Kilis-Pstrusinska 7, Beata Leszczynska 8, Irena Makulska 7, Dariusz Runowski 9, Roman Stankiewicz 10, Maria Szczepanska 11, Ryszard Wiercinski 12, Ryszard Grenda 3, Andrzej Kanik 13, Jacek A. Pietrzyk 4, Maria Roszkowska-Blaim 8, Krystyna Szprynger 11, Jacek Zachwieja 9, Maria M. Zajaczkowska 5, Walentyna Zoch-Zwierz 12, Danuta Zwolinska 7, and Aleksandra Zurowska 2

1 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Poland
2 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Gdansk, Poland
3 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Warszawa (IP CZD), Poland
4 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Kraków, Poland
5 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Lublin, Poland
6 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Szczecin, Poland
7 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Wroclaw, Poland
8 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Warszawa (AM), Poland
9 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Poznan, Poland
10 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Torun, Poland
11 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Zabrze, Poland
12 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Bialystok, Poland
13 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute of Lódz and Pediatric Dialysis Centers, Rzeszów, Poland

* To whom correspondence should be addressed.
Marcin Tkaczyk, E-mail: mtkaczyk{at}uni.lodz.pl



  Abstract

Background. The aim of this nationwide analysis was to assess the incidence and current treatment profile of arterial hypertension in children undergoing chronic haemodialysis or peritoneal dialysis and attitudes of paediatric nephrologists towards the choice of antihypertensive drugs in their patients.

Methods. The study group consisted of 134 children (89 males, 45 females, mean age 10.7±5 years) from all 13 paediatric dialysis centres in Poland. The data were gathered through a questionnaire for each patient dialysed in November 2004.

Results. The overall incidence of hypertension in the study group was 55% (74 of 134 patients; 47 males, 27 females). The incidence rate was similar in boys and girls (53 vs 60%) and in those on haemodialysis and peritoneal dialysis (56 vs 54%). Chronic glomerulonephritis as an underlying renal disease was significantly more frequent in the hypertensive than in the normotensive subjects (37 vs 10%, P = 0.004). Residual urine output was higher in normotensives (41 vs 10 ml/kg body weight; P<0.001). Among those treated with antihypertensives: 32% were treated by monotherapy, 36% received two drugs, 22% received three drugs, while 7% received ≥4 drugs. The therapy was effective in only 57% of subjects. We observed no differences in biochemical and clinical parameters between those who responded to the therapy and those who failed to do so. Calcium channel blockers constituted the most frequently administered class of drugs [73% of children; in 43 out of 48 (90%) combined with other drugs, but in 11 out of 24 (46%) as a monotherapy]. In monotherapy, angiotensin-converting enzyme inhibitors and calcium channel blockers were administered most frequently.

Conclusion. We conclude that the incidence of hypertension in dialysis children in Poland is high (55%). The effectiveness of antihypertensive treatment is rather low (58%) and the choice of drugs is limited.

Keywords: antihypertensive therapy; arterial hypertension; children; dialysis.
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