We suggest the following:
- When measuring BP in CYP on dialysis, the clinical setting and assessment method should be standardised. (2C)
- The best accepted practice for diagnosing hypertension in CYP on dialysis is with 24-hour ABPM. This should be performed at least annually once children reach a height of 120 cm. (2B)
- If ABPM is not feasible, standardised in-centre BP measurements and/or home BP monitoring (HBPM), should be used to assess BP control. (2D)
- For CYP receiving in-centre haemodialysis, BP should be monitored at every dialysis session (including pre-, intra- and post-dialysis measurements), to aid with assessment of required fluid removal. This should be done in conjunction with weight measurement and clinical evaluation of fluid status. (2C)
- For CYP on dialysis, BP should be targeted to <90th percentile for age, height and sex on non-dialysis days. (2D)
- There is inadequate evidence to provide target BP ranges for HBPM in CYP on dialysis although this method may be used as an adjunct to in-centre measurements. (2D)
- For CYP on dialysis, baseline and annual echocardiography should be performed to assess for morphological left ventricular changes that may indicate hypertension-mediated organ damage. (2C)
- For CYP with elevated BP on dialysis, salt intake should not exceed the age-related upper limit of recommended daily intake (RDI) although nutritional requirements should be regularly reviewed by dietetic colleagues. (2B)
- Antihypertensive medications should be considered if BP remains uncontrolled despite lifestyle interventions (e.g. fluid and salt restriction) and optimised fluid removal, particularly in the context of underlying target organ damage. (2C)
- When prescribing antihypertensive medications for CYP on dialysis, there is insufficient evidence to support the first-line use of any specific single agent or drug class. Both patient-specific factors, including the pharmacokinetics and dialysability of a drug (Appendix D), should be considered with the support of pharmacist colleagues. (2D)