Initial Management Of Hypertensive Disorders In Youth With And Without Chronic Kidney Disease

Hypertension (HTN) and target organ injury (TOI) are common in youth with chronic kidney disease (CKD). Understanding current TOI screening and treatment practices in this population will help identify gaps in implementation of HTN management. Our objective was to determine initial management of youth with and without CKD at first visit to a subspecialist for HTN disorder, hypothesizing that youth with CKD are more likely to have anti-hypertensive medication and echocardiogram (ECHO) ordered. Interim cross-sectional analysis of baseline EHR data from youth referred for HTN disorders in the multisite retrospective SUPERHERO Registry. Inclusion criteria were age <19 years and initial subspecialty clinic visit for HTN disorders by ICD-10 codes from 1/1/2015-12/31/2022. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. Our exposure was any-stage CKD by ICD-10 codes. Outcomes were orders placed for anti-hypertensive medication, ECHO, or referral to dietician or weight management clinic. We used unadjusted generalized linear models. Of 11,580 participants, 488 (4%) had a CKD diagnosis (Table). Youth with at least one CKD ICD-10 code were more likely to be prescribed an anti-hypertensive medication (RR 1.76; 95% CL 1.47 to 2.1) and less likely to have an ECHO order (RR 0.52; 95% CL 0.41 to 0.67) or be referred to a dietician (RR 0.51; 95% CL 0.26 to 0.98) or weight management clinic (RR 0.24; 95% CL 0.06 to 0.95). Our findings reflect a need for better implementation of TOI screening for youth with CKD and HTN. Future steps include validation of data and longitudinal data collection on this cohort to follow change in practice.