613 - Impact of Blood Pressure Control During Adolescence on Kidney Health Outcomes in Young Adults with Chronic Kidney Disease

Publication Number: 613.5561

Christopher B. Forrest, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Morgan Botdorf, Childrens Hospital of Philadelphia, Horsham, PA, United States; Dorey Glenn, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Jarcy Zee, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kimberley Dickinson, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kaleigh Wieand, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Amy Goodwin Davies, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Chronic kidney disease (CKD) is characterized by irreversible kidney function loss, resulting in significant morbidity, mortality, and healthcare costs. Management of elevated blood pressure (BP) is a critical intervention to slow CKD progression and reduce cardiovascular risk. However, there is limited real-world longitudinal data on how BP control during adolescence affects the progression to kidney failure.

Objective: This study assessed the effect of BP control during adolescence (14-17 years) on kidney replacement therapy (KRT) or death during young adulthood (18-30 years).

Design/Methods: We analyzed electronic health records (EHRs) of 2,575 youth from 15 medical centers as part of the PRESERVE study. EHR data were linked with the United States Renal Data System registry, which provided complete information on KRT and mortality, the outcomes of interest. All youth had mild-to-moderate CKD, at least one nephrologist visit, and three valid BP measurements between ages 14 and 17. BP control was defined as the percentage of time during which blood pressure exceeded the 90th percentile. Cox proportional hazard models were used to assess the relationship between BP control and KRT/death, adjusting for sex, race/ethnicity, RAAS blockade use, CKD etiology, number of BP measurements, eGFR, medical complexity, and proteinuria. Separate hazard ratios (HR) were estimated at the follow-up ages of 18-19 years, 19-20 years, 20-23 years, and 23-30 years.

Results: All patients were 18 years old at the start follow-up. Forty six percent of the sample were female, and the mean duration of follow-up was 7.67 years. A total of 119 participants (4.6%) experienced the outcome. Every 10% increase in time spent with BP above the 90th percentile during ages 14-17 was associated with a 1.28 times higher hazard of KRT or death between 18 and 19 years old. The impact of blood pressure control during adolescence decreased over time: the HR for ages 19-20 was 1.16 (95% CI: 0.99, 1.35) and for ages 20-23 was 1.08 (95% CI: 0.98, 1.20). For those aged 23 and older, it dropped to 0.98 (95% CI: 0.81, 1.18), indicating no significant increase in risk.

Conclusion(s): This study provides real-world evidence that controlling BP during adolescence helps preserve kidney function in early adulthood, reducing the risk of KRT or mortality. The benefit is most significant in the early years after adolescence, highlighting the importance of early BP management in adolescents with CKD for long-term kidney health.