ArticlePediatric nephrology (Berlin, Germany)2026
Is there an interaction between hypertension and proteinuria in pediatric chronic kidney disease progression? Evidence from the SP-CKD-Kids cohort.
Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHypertension and proteinuria are established risk factors for chronic kidney disease (CKD) progression in children. Given their pathophysiological interrelationship, whether their coexistence produces a multiplicative interaction remains uncertain. We evaluated this interaction in a Brazilian pediatric cohort.
methodsThis multicenter prospective cohort (SP-CKD-Kids) included 254 children and adolescents aged 1-17 years at study entry with CKD stages 3-4, followed for a median of 3.2 years. The composite outcome comprised death, initiation of kidney replacement therapy, or > 50% decline in estimated glomerular filtration rate (eGFR). Cox models were adjusted for age, sex, baseline eGFR, and CKD etiology. Multiplicative interaction was assessed using a hypertension × proteinuria product term, and statistical power was evaluated by simulation.
resultsHypertension was present in 67.3% of participants and proteinuria in 77.1%; 98 participants (38.6%) experienced the composite outcome. After adjustment, hypertension (hazard ratio [HR] 1.7; 95% confidence interval [CI] 1.0-2.8) and proteinuria (HR 3.5; 95% CI 1.7-7.0) remained independently associated with CKD progression. Participants with both conditions had the highest risk compared with those with neither condition (HR 8.4; 95% CI 2.1-34.2). The multiplicative interaction was not statistically significant (HR 0.6; 95% CI 0.1-3.0; p = 0.507), and simulation indicated limited power to detect interaction effects.
conclusionsHypertension and proteinuria were independent predictors of CKD progression in children. Although no statistically significant multiplicative interaction was detected, the wide confidence interval around the interaction term indicates that a clinically relevant interaction cannot be excluded.
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