Chronic kidney disease is a medical condition that affects many children worldwide. While treatment options are available, determining the optimal target blood pressure for reducing adverse cardiac remodeling has been a challenge. A clinical trial called HOT-KID sought to explore this issue and provide insights into the ideal blood pressure levels for children with chronic kidney disease.
The HOT-KID trial was a study that was conducted in 14 medical centers in England and Scotland. The study included children between 2 and 15 years old who had chronic kidney disease but were not at the most advanced stage. They also had to be able to be followed up for two years. Children who were taking medication for high blood pressure were allowed to participate, as long as they could switch to a different type of medication if needed.
The people in the study were randomly put into two groups: standard treatment and intensive treatment. The standard group got their blood pressure checked at the doctor's office and it was supposed to be within a certain range. The intensive group had to keep their blood pressure lower than most people. They were given medication that helps control blood pressure, and the dose was adjusted every few weeks until they reached their target blood pressure levels.
The main thing the researchers looked at in this study was how the heart was affected by the different treatments. They measured the size of the heart's left ventricle using a special machine and compared the results between the two groups. They also looked at other things like the thickness of the heart wall, how well the kidneys were working, and any negative effects that might have happened. They included all the children who were part of the study, no matter what their blood pressure levels were, to make sure their results were accurate.
The HOT-KID study found that kids with chronic kidney disease who had lower blood pressure had better heart health. However, there was no significant difference in heart health between those who got standard treatment and those who got more intense treatment. Both groups ended up with healthy heart measurements at the end of the study.
The study found that the thickness of the heart wall was more noticeable than the size of the heart at the beginning of the trial. The group that received intensive treatment had a greater reduction in the thickness of the heart wall compared to the group that received standard treatment. However, during the study, six participants developed severe kidney disease, with three in each group.
The HOT-KID trial found that controlling blood pressure is important for children with chronic kidney disease to prevent changes in their hearts. The study suggests that keeping blood pressure at a level close to the middle range is the best way to prevent these changes. The trial also found that intensive treatment to lower blood pressure was safe and did not lead to worse kidney problems or more side effects than the standard treatment.
The HOT-KID trial provides valuable insights into the optimal blood pressure targets for reducing adverse cardiac remodeling in children with chronic kidney disease. These findings may inform clinical practice and help healthcare providers make more informed decisions about treating this vulnerable population. Further research is needed to confirm these results and explore additional treatment options for children with chronic kidney disease.