62 - Effects Of Medication Non-Adherence On Blood Pressure Control And Target Organ Damage In Children With Chronic Kidney Disease
Sunday, April 24, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 62 Publication Number: 62.341
Rushelle Byfield, Children's Hospital of Philadelphia, PHILADELPHIA, PA, United States; Sandra Amaral, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Rui Xiao, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Susan Furth, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Jordana B. Cohen, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
Fellow Children's Hospital of Philadelphia PHILADELPHIA, Pennsylvania, United States
Background: Children with chronic kidney disease (CKD) are at high risk for cardiovascular disease (CVD)-related morbidity and mortality. Hypertension (HTN) is a major modifiable risk factor for the development CVD and progression of CKD. Non-adherence to anti-hypertensive (AHT) medication may prevent adequate blood pressure (BP) control and contribute to adverse outcomes in children with CKD.
Objective: To determine if degree of adherence is associated with 1) differences in ambulatory blood pressure monitoring (ABPM) profiles, 2) severity of renal dysfunction (estimated glomerular filtration rate [eGFR], proteinuria), or 3) cardiac structural abnormalities (left ventricular mass index [LVMI]) among children with CKD.
Design/Methods: Analysis of data from the Chronic Kidney Disease in Children (CKiD) Study, a multicenter, prospective, observational cohort study of children with CKD stages 2-3. The current study was restricted to participants with treated HTN and available ABPM/echocardiogram data. Adherence was assessed by self-report and degree of adherence defined as proportion of missed AHT medication doses out of total prescribed doses in the 7 days prior to ABPM. Linear regression models with propensity score weighting were used to assess if degree of adherence is associated with differences in ABPM profiles, baseline eGFR, proteinuria, and LVMI.
Results: Any non-adherence to AHT medications was found in 82/519 (16%) patients. Race, ethnicity, income, maternal education, glomerular disease, and eGFR were not significantly associated with adherence. Non-adherent patients were older (11 vs 13 years, p=0.013), more often male (73 vs 24%, p=0.003), and had longer CKD duration (12 vs 10 years, p=0.03). There were no significant associations between baseline degree of adherence and ABPM parameters including 24-hr mean systolic BP and 24-hr mean arterial pressure. Furthermore, there were no significant associations between baseline degree of adherence and markers of target organ damage including eGFR, proteinuria and LVMI.Conclusion(s): AHT medication non-adherence is common among children with CKD however there are no significant associations between degree of adherence and ABPM profiles or markers of target organ damage. This may reflect misclassification of adherence due to self-report or unique pharmacokinetics in children that could allow for less stringent dosing of AHT medications. In addition, clinical study participants may be more motivated to be adherent than the general population. Further studies of the relationship of adherence to long term outcomes using objective measures of adherence are needed. Rushelle Byfield CVRushelle Byfield CV 2021.pdf Table 2. Adjusted models evaluating the association of proportion of missed medication doses with baseline ambulatory blood pressure parameters and markers of target organ damageCI, confidence interval, SBP, systolic blood pressure, DBP, diastolic blood pressure, MAP, mean arterial pressure