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Kidney Week

Abstract: TH-PO433

Ambulatory Blood Pressure Monitoring: Assessing Capacity and Practice Patterns of the Improving Renal Outcomes Collaborative (IROC)

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Varnell, Charles D., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Dahale, Devesh S., Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Ambulatory Blood Pressure Monitoring (ABPM) is recommended for assessment of hypertension in patients with a kidney transplant (KTx) and/or chronic kidney disease (CKD). IROC is a multicenter learning health system comprised of patients and families, clinicians, and researchers from 23 pediatric nephrology centers, working together to improve health of patients with kidney disease.

Methods

23 IROC centers were surveyed from July to December 2017 and asked to report the number of transplant and CKD patients under their care, their center’s protocol for ABPM, ABPM unit availability vs need, ABPM return mechanism, challenges and barriers to performing ABPM.

Results

All centers responded to the survey and cumulatively care for approximately 4256 CKD and 2497 KTx patients. There were an average (std dev) of 109 (+/- 51) KTx and 224 (+/- 114) CKD patients at each center. 17 (74%) centers report intending to use the IROC protocol: yearly if last ABPM was abnormal OR every 3 years if last ABPM was normal for patients > 7 years old and 1 year post-transplant. One center reported once a year screening regardless of last ABPM result. Five centers reported using other protocols. With regard to ABPM device needs, 16 (70%) of centers report a shortage of units, 1 center reports just enough units, and 6 (26%) of centers report excess units. The majority of centers (20/23, 87%) report ABPM devices are returned by the patient or through courier/postal service. The main barriers to performing ABPM per protocol are insurance approval, workflow, and shortage of ABPMs.

Conclusion

Three-quarters of IROC centers plan to use the recommended IROC ABPM protocol, however many centers report a shortage of ABPM units for the number of patients cared for. In order to decrease the negative impact of barriers to performing ABPM according to recommendations and standards, structured quality improvement is underway to optimize workflow and utilization of existing ABPM units.