L-type calcium channel blocker use and proteinuria among children with chronic kidney diseases

Abstract

Background: Hypertension is common among children with chronic kidney disease (CKD), and dihydropyridine calcium channel blockers (dhCCBs) are frequently used as treatment. The impact of dhCCBs on proteinuria in children with CKD is unclear.

Methods: Data from 722 participants in the Chronic Kidney Disease in Children (CKiD) longitudinal cohort with a median age of 12 years were used to assess the association between dhCCBs and log transformed urine protein/creatinine levels as well as blood pressure control measured at annual visits. Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) use was evaluated as an effect measure modifier.

Results: Individuals using dhCCBs had 18.8% higher urine protein/creatinine levels compared to those with no history of dhCCB or ACEi and ARB use. Among individuals using ACEi and ARB therapy concomitantly, dhCCB use was not associated with an increase in proteinuria. Those using dhCCBs had higher systolic and diastolic blood pressures.

Conclusions: Use of dhCCBs in children with CKD and hypertension is associated with higher levels of proteinuria and was not found to be associated with improved blood pressure control.

Keywords: Calcium channel blocker; Children; Chronic kidney disease; Hypertension; Proteinuria.

Conflict of interest statement

Conflicts of interest The authors declare no competing interests.

Figures

Fig. 1

Adjusted percent differences in proteinuria with 95% confidence intervals by no dihydropyridine calcium channel blocker (dhCCB) use, current dhCCB use, discontinued dhCCB use, stratified by no ACEi/ARB use, current ACEi/ARB use, and discontinued ACEi/ARB use (n = 2503 person-visits). The reference group comprises person-visits reporting no dhCCB use and no ACEi/ARB use. Percent differences based on log-linear regression models with generalized estimating equations (GEE) to account for the dependencies of within-person repeated measurements. All models were adjusted for age, sex, race, underlying glomerular vs. non-glomerular diagnosis, previous GFR, previous systolic and diastolic blood pressure z-scores, and previous proteinuria level. Estimates in gray are based on less than 20 person-visits; levels among those who discontinued both ACEi/ARB and dhCCBs were not estimated (n.e.) due to less than 5 person-visits in this group

Fig. 2

Adjusted differences in systolic blood pressure z-score with 95% confidence intervals by no dihydropyridine calcium channel blocker (dhCCB) use, current dhCCB use, discontinued dhCCB use, stratified by no ACEi/ARB use, current ACEi/ARB use, and discontinued ACEi/ARB use (n = 2503 person-visits). The reference group comprises person-visits reporting no dhCCB use and no ACEi/ARB use. Differences based on log-linear regression models with generalized estimating equations (GEE) to account for the dependencies of within-person repeated measurements. All models were adjusted for age, sex, race, underlying glomerular vs. non-glomerular diagnosis, previous GFR, previous systolic and diastolic blood pressure z-scores, and previous proteinuria level. Estimates in gray are based on less than 20 person-visits; levels among those who discontinued both ACEi/ARB and dhCCBs were not estimated (n.e.) due to less than 5 person-visits in this group.

Fig. 3

Adjusted differences in diastolic blood pressure z-score with 95% confidence intervals by no dihydropyridine calcium channel blocker (dhCCB) use, current dhCCB use, discontinued dhCCB use, stratified by no ACEi/ARB use, current ACEi/ARB use, and discontinued ACEi/ARB use (n = 2503 person-visits). The reference group comprises person-visits reporting no dhCCB use and no ACEi/ARB use. Differences based on log-linear regression models with generalized estimating equations (GEE) to account for the dependencies of within-person repeated measurements. All models were adjusted for age, sex, race, underlying glomerular vs. non-glomerular diagnosis, previous GFR, previous systolic and diastolic blood pressure z-scores, and previous proteinuria level. Estimates in gray are based on less than 20 person-visits; levels among those who discontinued both ACEi/ARB and dhCCBs were not estimated (n.e.) due to less than 5 person-visits in this group