Researchers at Children’s Hospital of Philadelphia (CHOP) reported recently in JAMA Pediatrics that children and teens with chronic kidney disease (CKD) who started renin–angiotensin–aldosterone system (RAAS) inhibitors – drugs that block the system controlling blood pressure and blood volume – were less likely to progress to dialysis or need a kidney transplant than similar patients who began treatment with calcium channel blockers (CCBs), commonly used as an alternative first‑line antihypertensive medicine in children with CKD.
The findings are based on data from the Preserving Kidney Function in Children with CKD (PRESERVE) study (January 2009–December 2020). The multi-center PCORnet® study, to inform shared decision-making about blood pressure treatment in pediatric CKD, included more than 20,000 pediatric patients and used electronic health records (EHRs) from 15 health systems across five research networks (PEDSnet, Science, Technology and Research [STAR], Greater Plains Collaborative [GPC], PaTH, and One-Florida+).
In the study, researchers noted that one of the most important clinical goals for children with CKD and their families is keeping the kidneys working as long as possible. About half of children with CKD have high blood pressure, which is a common, treatable cause of worsening kidney function. Although controlling blood pressure is central to care, many children still have uncontrolled hypertension. Because few clinical trials and limited observational studies exist in this population, clinicians and families previously had limited evidence to guide treatment choices.
In this comparative‑effectiveness analysis, investigators followed 2,762 children and adolescents who started either a RAAS inhibitor or a CCB and assessed outcomes over two years. After accounting for differences between groups, the researchers found that children who started RAAS inhibitors were about 40% less likely to need dialysis or a kidney transplant than those who started CCBs. The rates of issues like large drops in kidney function or very low kidney function were also lower in patients who started with RAAS inhibitors. RAAS inhibitors did a better job controlling blood pressure and kids on them spent less time with high systolic readings.
“Comparative trials of blood pressure medicines in pediatric CKD have been scarce, making these results especially significant,” said Michelle Denburg, MD, MSCE, the study’s lead author and attending physician in the Division of Nephrology. “The size of the PRESERVE study enabled us to compare the real-world effectiveness of the most widely used antihypertensive medications in children with CKD, and while observational, the results support using RAAS inhibitors as a first-line choice for treating high blood pressure in pediatric CKD.”
The research was funded through Patient-Centered Outcomes Research Institute (PCORI) award RD-2020C2-20338.
Denburg et al. “Comparative Effectiveness of Antihypertensive Medications in Children with Chronic Kidney Disease.” JAMA Pediatr. Online March 16, 2026. DOI: 10.1001/jamapediatrics.2026.0207.
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Researchers at Children’s Hospital of Philadelphia (CHOP) reported recently in JAMA Pediatrics that children and teens with chronic kidney disease (CKD) who started renin–angiotensin–aldosterone system (RAAS) inhibitors – drugs that block the system controlling blood pressure and blood volume – were less likely to progress to dialysis or need a kidney transplant than similar patients who began treatment with calcium channel blockers (CCBs), commonly used as an alternative first‑line antihypertensive medicine in children with CKD.
The findings are based on data from the Preserving Kidney Function in Children with CKD (PRESERVE) study (January 2009–December 2020). The multi-center PCORnet® study, to inform shared decision-making about blood pressure treatment in pediatric CKD, included more than 20,000 pediatric patients and used electronic health records (EHRs) from 15 health systems across five research networks (PEDSnet, Science, Technology and Research [STAR], Greater Plains Collaborative [GPC], PaTH, and One-Florida+).
In the study, researchers noted that one of the most important clinical goals for children with CKD and their families is keeping the kidneys working as long as possible. About half of children with CKD have high blood pressure, which is a common, treatable cause of worsening kidney function. Although controlling blood pressure is central to care, many children still have uncontrolled hypertension. Because few clinical trials and limited observational studies exist in this population, clinicians and families previously had limited evidence to guide treatment choices.
In this comparative‑effectiveness analysis, investigators followed 2,762 children and adolescents who started either a RAAS inhibitor or a CCB and assessed outcomes over two years. After accounting for differences between groups, the researchers found that children who started RAAS inhibitors were about 40% less likely to need dialysis or a kidney transplant than those who started CCBs. The rates of issues like large drops in kidney function or very low kidney function were also lower in patients who started with RAAS inhibitors. RAAS inhibitors did a better job controlling blood pressure and kids on them spent less time with high systolic readings.
“Comparative trials of blood pressure medicines in pediatric CKD have been scarce, making these results especially significant,” said Michelle Denburg, MD, MSCE, the study’s lead author and attending physician in the Division of Nephrology. “The size of the PRESERVE study enabled us to compare the real-world effectiveness of the most widely used antihypertensive medications in children with CKD, and while observational, the results support using RAAS inhibitors as a first-line choice for treating high blood pressure in pediatric CKD.”
The research was funded through Patient-Centered Outcomes Research Institute (PCORI) award RD-2020C2-20338.
Denburg et al. “Comparative Effectiveness of Antihypertensive Medications in Children with Chronic Kidney Disease.” JAMA Pediatr. Online March 16, 2026. DOI: 10.1001/jamapediatrics.2026.0207.
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