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Original article
Hypertension in autosomal dominant polycystic kidney disease: a meta-analysis
  1. Matko Marlais1,
  2. Oliver Cuthell2,
  3. Dean Langan1,
  4. Jan Dudley2,
  5. Manish D Sinha3,
  6. Paul J D Winyard1
  1. 1Institute of Child Health, University College London, London, UK
  2. 2Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
  1. Correspondence to Professor Paul J D Winyard, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK; p.winyard{at}ucl.ac.uk

Abstract

Context Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that can cause hypertension during childhood, but the true prevalence of hypertension during childhood is not known.

Objective We undertook a systematic review and meta-analysis to determine the prevalence of hypertension in children with ADPKD.

Data sources Systematic review of articles published between 1980 and 2015 in MEDLINE and EMBASE.

Study selection Studies selected by two authors independently if reporting data on prevalence of hypertension in children and young persons aged <21 years with a diagnosis of ADPKD. Observational series were included with study populations of >15 children. Articles were excluded if inadequate diagnostic criteria for hypertension were used. Studies with selection bias were included but analysed separately.

Data extraction Data extracted on prevalence of hypertension, proteinuria and reduced renal function using standardised form. Meta-analysis was performed to calculate weighted mean prevalence.

Results 903 articles were retrieved from our search; 14 studies met the inclusion criteria: 1 prospective randomised controlled trial; 8 prospective observational studies; and 5 retrospective cross-sectional studies. From 928 children with clinically confirmed ADPKD, 20% (95% CI 15% to 27%) were hypertensive. The estimated prevalence of proteinuria in children with ADPKD is 20% (8 studies; 95% CI 9% to 40%) while reduced renal function occurred in 8% (5 studies; 95% CI 2% to 26%).

Limitations Studies showed a high degree of methodological heterogeneity (I2=73.4%, τ2=0.3408, p<0.0001). Most studies did not use ambulatory blood pressure (BP) monitoring to diagnose hypertension.

Conclusions In this meta-analysis we estimate 20% of children with ADPKD have hypertension. In the population, many children with ADPKD are not under regular follow-up and remain undiagnosed. We recommend that all children at risk of ADPKD have regular BP measurement.

  • Nephrology
  • Paediatric Practice

https://doi.org/10.1136/archdischild-2015-310221

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    Footnotes

    • Contributors MM conceived the idea for the study, designed the study methodology, selected articles for inclusion, performed meta-analysis, drafted the initial manuscript and approved the final manuscript as submitted. OC designed the study methodology, selected articles for inclusion in this study, reviewed and revised the manuscript and approved the final manuscript as submitted. DL provided expert statistical advice and ran additional analysis for this study, reviewed and edited the revised manuscript and approved the final manuscript as submitted. JD and MDS designed the study methodology, reviewed the study selection and meta-analysis, reviewed and revised the manuscript and approved the final manuscript as submitted. PJDW conceived the idea for the study, designed the study methodology, selected articles for inclusion, reviewed the meta-analysis, reviewed and revised the manuscript, and approved the final manuscript as submitted.

    • Funding This study received no specific funding but was supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. MDS acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.