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Time to referral to a nephrology clinic for pediatric hypertension

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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.

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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).

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Hamby, T., Pueringer, M.R., Noorani, S. et al. Time to referral to a nephrology clinic for pediatric hypertension. Pediatr Nephrol (2020). https://doi.org/10.1007/s00467-020-04490-x

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Keywords

  • Hypertension
  • Elevated blood pressure
  • Referral
  • Children