Hypertension (HTN) contributes to progression of renal failure and is an important modifiable risk factor for cardiovascular (CV) morbidity/mortality. Little is known about whether any specific medications are more effective than others in reducing BP for these patients, or whether group-level treatment recommendations would be appropriate at all. Given the complex interaction of many factors in the pathophysiology of HTN in CKD, including reduced nephron mass, sodium retention, volume expansion, RAAS activation, sympathetic nervous system over-activity, and endothelial dysfunction, n-of-1 trials may be the best strategy to systematically individualize the HTN management approach in this particularly vulnerable and understudied population. Traditional large-scale RCTs are less feasible in pediatric kidney disease due to sample size limitations, yet given the high baseline risk for CV disease in children with CKD it is critically important to determine whether n-of-1 trials should be incorporated into clinical practice to optimize BP control and potentially slow the decline of kidney function and reduce CV morbidity and mortality.
Feasibility of N-of-1 Trials in Children with Hypertension and Chronic Kidney Disease (NICHE-CKD) study
Funding Source:
Participating PEDSnet Sites:
- Nationwide Children’s Hospital
- Children’s Hospital of Philadelphia
- Cincinnati Children’s Hospital Medical Center
- Children’s Hospital Colorado
- Nemours Children’s Health
- St. Louis Children’s Hospital
- Seattle Children’s Hospital
Study Investigator:
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