Regular Healthcare Visits Improve Blood Pressure Control in Youth with Chronic Kidney Disease

Research study background

Youth with chronic kidney disease (CKD) often struggle with hypertension or elevated blood pressure (BP), which increases their risk of cardiovascular complications and CKD progression. Despite well-established risks and guidelines recommending lower blood pressure targets, it’s unclear why suboptimal hypertension diagnosis and treatment persist within this population.

This study explored the relationship between blood pressure control and the frequency of healthcare provider visits among a cohort of children with CKD and a history of elevated blood pressure. Eliza Blanchette, MD, pediatric nephrologist at the Kidney Center at Children’s Hospital Colorado, contributed to this multi-institutional study. The team used longitudinal data from the Chronic Kidney Disease in Children Study (CKiD), which was established in 2003 and now includes more than 1,000 participants from 50 sites in the U.S. and Canada. Data generated from the ongoing study has provided critical insights into the progression, risk factors and outcomes of CKD.

Here, the research team analyzed data from 689 participants across 2,916 well and sick visits (excluding emergency department encounters). They hypothesized that poor blood pressure control was linked to infrequent provider follow-up between annual CKiD study visits. Blood pressure control was defined as a normal mean clinic systolic blood pressure and diastolic blood pressure at a CKiD visit. The primary analysis included three models: unadjusted, minimally adjusted for sociodemographic variables and fully adjusted for CKD severity.

Across all models, children with three to five healthcare visits per year had significantly higher odds of blood pressure control compared to those who had no contact with providers. Children with fewer than three visits or more than five visits annually did not consistently show significant improvement in blood pressure control.

A secondary analysis focused on participants with a history of hypertension, or higher blood pressure levels. Those with more than five healthcare visits per year had greater odds of blood pressure control, suggesting more frequent provider contact may potentially benefit this group. The study authors noted that this association could not be explained by self-reported adherence to prescribed anti-hypertensive medication.

While social determinants of health were not an emphasis of this study, the data identified a significant link between individuals who self-reported as Black and poor blood pressure control across all models.

Clinical implications 

These findings suggest that regular healthcare provider contact (three to five annual visits) may support better blood pressure management in children with CKD and hypertension and more frequent visits may benefit children with more severely elevated blood pressure.

Future studies are needed to identify and develop more precise strategies for blood pressure management in children with CKD and hypertension and further examine the impact of sociodemographic factors on health outcomes.