Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Time to referral to a nephrology clinic for pediatric hypertension



Rates of pediatric hypertension have increased, but adherence to the current diagnostic criteria for hypertension (HTN) in pediatrics is not well known. We investigated the timeline and predictors of time to referral for those referred to nephrology for elevated blood pressure (EBP).


A retrospective study was conducted on patients, aged 3–18 years, referred to a nephrology clinic for EBP over a 3-year period. Patients were excluded if they were referred previously, were referred for other conditions, or did not have ≥ 1 prior visit with EBP. Analyses were performed to determine whether sex, age, ethnicity, socioeconomic status, and obesity predicted number of prior visits with EBP and time to referral.


There were 120 patients (64% male; 53% obese) included and 82 (68%) had ≥ 3 prior visits with EBP ≥ 95%. Medians were as follows: 15.08 years of age at referral; 5 visits with EBP and 3.45 years from first EBP ≥ 90%; 4 visits with EBP and 1.42 years from third EBP ≥ 95%. No variables significantly predicted number of prior visits with EBP or time to referral from the first EBP. Starting with the third EBP ≥ 95%, only obesity significantly predicted number of prior visits and time to referral: Obese patients had more visits (p = 0.01), and took longer to be referred (p = 0.03) than healthy patients.


Patients with EBP were generally not referred to nephrology promptly, which was especially true for obese patients. Further research is needed to identify interventions to improve time to referral for EBP.

This is a preview of subscription content, log in to check access.


  1. 1.

    Hope KD, Zachariah JP (2019) Predictors and consequences of pediatric hypertension: have advanced echocardiography and vascular testing arrived? Curr Hypertens Rep 21:54

  2. 2.

    Duzova A, Yalcinkaya F, Baskin E, Bakkaloglu A, Soylemezoglu O (2013) Prevalence of hypertension and decreased glomerular filtration rate in obese children: results of a population-based field study. Nephrol Dial Transplant 28(Suppl 4):iv166–iv171

  3. 3.

    Rosner B, Cook NR, Daniels S, Falkner B (2013) Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension 62:247–254

  4. 4.

    Frankel R, Elangovan A, Kaelber DC (2016) Defining and diagnosing elevated blood pressure in children and adolescents. Curr Cardiovasc Risk Rep 10:43.

  5. 5.

    Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM, SUBCOMMITTEE ON SCREENING AND MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3).

  6. 6.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents.

  7. 7.

    A SAS Program for the 2000 CDC growth charts (ages 0 to <20 years). Centers for Disease Control and Prevention website https://wwwcdcgov/nccdphp/dnpao/growthcharts/resources/sashtm. Updated February 26, 2019. Accessed July 27, 2019

  8. 8.

    American Fact Finder. Updated July 1, 2019. Accessed July 27, 2019

  9. 9.

    Bijlsma MW, Blufpand HN, Kaspers GJ, Bokenkamp A (2014) Why pediatricians fail to diagnose hypertension: a multicenter survey. J Pediatr 164:173–177.e177

  10. 10.

    Boneparth A, Flynn JT (2009) Evaluation and treatment of hypertension in general pediatric practice. Clin Pediatr 48:44–49

  11. 11.

    Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298:874–879

  12. 12.

    Sorof JM, Poffenbarger T, Franco K, Bernard L, Portman RJ (2002) Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr 140:660–666

  13. 13.

    Obialo CI, Ofili EO, Quarshie A, Martin PC (2005) Ultralate referral and presentation for renal replacement therapy: socioeconomic implications. Am J Kidney Dis 46:881–886

  14. 14.

    Stabouli S, Sideras L, Vareta G, Eustratiadou M, Printza N, Dotis J, Kotsis V, Papachristou F (2015) Hypertension screening during healthcare pediatric visits. J Hypertens 33:1064–1068

  15. 15.

    Cha SD, Chisolm DJ, Mahan JD (2014) Essential pediatric hypertension: defining the educational needs of primary care pediatricians. BMC Med Educ 14:154

Download references


This study was conducted as part of the University of North Texas Health Science Center and Cook Children’s Pediatric Research Program (PRP).

Author information

Correspondence to Tyler Hamby.

Ethics declarations

This study was approved by the Cook Children’s Health Care System (CCHCS) Institutional Review Board.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Supplementary Table 1

(DOCX 14 kb).

Supplementary Fig. 1

Boxplot and dotplot of number of prior visits with EBP and time to referral in years from first EBP and from third EBP ≥95%. (PNG 100 kb).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hamby, T., Pueringer, M.R., Noorani, S. et al. Time to referral to a nephrology clinic for pediatric hypertension. Pediatr Nephrol (2020).

Download citation


  • Hypertension
  • Elevated blood pressure
  • Referral
  • Children