Effects of the strict control of blood pressure in pediatric renal transplant recipients-ESCORT trial
Language English Country Denmark Media print-electronic
Document type Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
Grant support
NPU I Nr. LO1503
National Sustainability Program I provided by the Ministry of Education Youth and Sports of the Czech Republic - International
PubMed
30537138
DOI
10.1111/petr.13329
Knihovny.cz E-resources
- Keywords
- blood pressure, children, hypertension, kidney transplantation, proteinuria,
- MeSH
- Blood Pressure Monitoring, Ambulatory MeSH
- Antihypertensive Agents therapeutic use MeSH
- Kidney Failure, Chronic physiopathology surgery MeSH
- Child MeSH
- Hypertension diagnosis etiology prevention & control MeSH
- Humans MeSH
- Adolescent MeSH
- Postoperative Complications diagnosis prevention & control MeSH
- Graft Survival physiology MeSH
- Prospective Studies MeSH
- Kidney Transplantation * MeSH
- Kidney Function Tests MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Names of Substances
- Antihypertensive Agents MeSH
OBJECTIVES: Strict BP control can retard progression of CKD in children. This prospective 3-year randomized controlled trial is aimed to investigate whether strict BP control can retard progression of chronic allograft dysfunction. METHODS: Twenty-three pediatric patients were randomly selected to the standard BP group (STAND, target 24-hour MAP 50-95th percentile, n = 11) or the intensified BP group (INTENS, target 24-hour MAP <50th percentile, n = 12). The primary endpoint was an annual reduction in eGFR (Schwartz formula, mL/min/1.73 m2 /y), secondary graft survival, BP, proteinuria, and safety. RESULTS: A total of 21 children (age at entry 11.2 (range 6.2-16.8) years) completed the study, with 73% of children in INTENS and 70% of children in STAND group reached their goal BP. Ambulatory indexed 24-hour MAP decreased significantly in INTENS group (from 0.94 (range 0.86-1.17) to 0.85 (range 0.79-1.01, P < 0.01)) but not in STAND group (from 0.93 (range 0.85-1.07) to 0.90 (range 0.84-1.01)). Proteinuria did not change significantly in either group (22.1 mg/mmol creatinine to 15.3 in STAND group vs 25.7 to 11.8 in INTENS group). The annual reduction in eGFR did not differ between the INTENS and STAND groups (-1.9 mL/min/1.73 m2 /y (range +6.4 to -14.3) vs -0.9 (range +4.0 to -8.5)). CONCLUSION: This first randomized controlled trial on strict BP control has demonstrated that strict BP control is feasible in 73% of children but the strict BP control does not lead to retardation of graft function decline in comparison with standard BP control. However, the results need to be interpreted with caution keeping the major limitation of the study, that is, small sample size in mind.
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