Journal Article

Hypertension in autosomal dominant polycystic kidney disease: a meta-analysis

Winyard, Paul J D, Langan, Dean, Dudley, Jan, Cuthell, Oliver, Sinha, Manish D, Marlais, Matko

2016

Overview

ContextAutosomal 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.ObjectiveWe undertook a systematic review and meta-analysis to determine the prevalence of hypertension in children with ADPKD.Data sourcesSystematic review of articles published between 1980 and 2015 in MEDLINE and EMBASE.Study selectionStudies 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 extractionData extracted on prevalence of hypertension, proteinuria and reduced renal function using standardised form. Meta-analysis was performed to calculate weighted mean prevalence.Results903 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%).LimitationsStudies 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.ConclusionsIn 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.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Adults / Age / Bias / Blood pressure / Childhood / Complications and side effects / Eligibility / Genetic Disorders / Glomerular Filtration Rate - physiology / Health risk assessment / Heterogeneity / Humans / Hypertension / Hypertension, Renal - etiology / Hypertension, Renal - physiopathology / Information Seeking / Information Sources / Kidney diseases / Kidneys / Maximum Likelihood Statistics / Measurement Techniques / Meta Analysis / Observational studies / Polycystic kidney disease / Polycystic Kidney, Autosomal Dominant - complications / Polycystic Kidney, Autosomal Dominant - physiopathology / Prevalence / Proteinuria - etiology / Proteinuria - physiopathology / Quality / Regression (Statistics) / Renal function / Risk factors / Search Strategies / Studies / Young Adults