Hammond John H, Ng Derek K, Blanchette Eliza D, Flynn Joseph T, Mitsnefes Mark M, Furth Susan L, Warady Bradley A, Brady Tammy M
Division of Pediatric Nephrology, Johns Hopkins Children's Center, Baltimore, MD, 21287, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Nephrol. 2025 Mar 24. doi: 10.1007/s00467-025-06743-z.
Prior studies in the CKiD (Chronic Kidney Disease in Children) cohort have shown poor blood pressure (BP) control over time. It is unclear whether the lack of BP control is associated with frequency of provider contact between annual study visits.
Six hundred eighty-nine CKiD participants with elevated BP or self-reported history of hypertension contributed longitudinal annual data (2,916 total visits). Provider visits were categorized as any well or sick visit, excluding emergency department visits. Repeated measures logistic regression quantified the association between number of visits over the last year (categorized as 0, 1-2, 3-5, 6-10 or > 10 visits) and BP control (defined as non-elevated BP at an annual CKiD visit). Models were unadjusted, minimally adjusted (controlling for sociodemographic factors), and fully adjusted (additionally controlling for chronic kidney disease (CKD) severity).
Compared to those with no interval healthcare provider visits over the prior year, participants with 3-5 visits had significantly greater odds of BP control across all models (unadjusted, OR 1.45, 95% CI 1.10-1.89; minimally adjusted, OR 1.36, 95% CI 1.03-1.79; fully adjusted, OR 1.36, 95% CI 1.01-1.81); those with fewer or more frequent visits did not consistently have significant improvement in BP control.
In this cohort of youth with CKD and elevated BP, interval healthcare provider contact of 3-5 visits per year between annual CKiD visits was associated with improved BP control; less and more frequent contact was not, even after adjusting for CKD severity. Optimal frequency of health visits by CKD and comorbidity severity deserves further study.
既往针对儿童慢性肾脏病（CKiD）队列的研究显示，随着时间推移血压（BP）控制情况不佳。目前尚不清楚血压控制不佳是否与年度研究访视之间的医疗服务提供者接触频率有关。
689名血压升高或有自我报告高血压病史的CKiD参与者提供了纵向年度数据（共2916次访视）。医疗服务提供者访视被分类为任何一次健康或患病访视，不包括急诊室访视。重复测量逻辑回归分析量化了过去一年访视次数（分类为0次、1 - 2次、3 - 5次、6 - 10次或>10次访视）与血压控制（定义为在年度CKiD访视时血压未升高）之间的关联。模型未进行调整、进行了最小程度调整（控制社会人口学因素）以及进行了完全调整（另外控制慢性肾脏病（CKD）严重程度）。
与前一年没有间隔医疗服务提供者访视的参与者相比，在所有模型中，有3 - 5次访视的参与者血压得到控制的几率显著更高（未调整，比值比[OR]为1.45，95%置信区间[CI]为1.10 - 1.89；最小程度调整，OR为1.36，95% CI为1.03 - 1.79；完全调整，OR为1.36，95% CI为1.01 - 1.81）；访视次数较少或较多的参与者在血压控制方面并未持续出现显著改善。
在这个患有CKD且血压升高的青年队列中，年度CKiD访视之间每年进行3 - 5次间隔医疗服务提供者接触与血压控制改善相关；即使在调整了CKD严重程度之后，接触次数较少和较多均未显示出这种关联。CKD和合并症严重程度对应的最佳健康访视频率值得进一步研究。
