Chronic Kidney Disease: Treatment of Comorbidities II (Hypertension, Anemia, and Electrolyte Management)

Purpose of review: While the causes of chronic kidney disease (CKD) are different in children than their adult counterparts, many comorbidities are commonly encountered by both populations. Particularly concerning is that these entities contribute to the decrease in lifespan in children with CKD. Amongst these conditions are hypertension, anemia, and electrolyte abnormalities. While these can cause metabolic derangements individually, they each contribute to the development and progression of cardiovascular disease, which in turn, exponentially increases mortality (Vidi Curr Opin Pediatr 30 (2): 247-251, 2018). It has been estimated that the mortality rate of children with CKD is 30 times higher than their healthy peers (Ferris et al. Blood Purif 41 (1-3): 205-10, 2016). As these conditions are each treatable, optimization of medical management can lessen the risk of death in this high-risk population. Recent findings: Hypertension remains underdiagnosed in children with CKD despite a high prevalence. The American Academy of Pediatrics released the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents in 2007, in which experts outline the need for aggressive diagnosis and treatment of hypertension. While the mainstay of anemia management remains correction of iron deficiency and erythropoiesis stimulating agents, long-acting erythropoietic agents offer an alternative option to traditional management. Electrolyte abnormalities including metabolic acidosis and hyperkalemia must be addressed in order to optimize clinical outcomes. Summary: The care of children with CKD remains complex with the need for a wholistic approach. Although the injury initiates within the kidneys, the associated comorbidities have systemic consequences. Some of these include hypertension, anemia, and electrolyte abnormalities. The early identification of these conditions as well as aggressive treatment can improve the health of these children.