Doctor-Teen Communication & Antihypertensive Adherence in Chronic Kidney Disease

描述（由申请人提供）：高血压是慢性肾脏疾病（CKD）进展的最重要的独立危险因素之一。最近完成的ESCAPE试验的结果强调了血压控制作为减缓CKD进展的一种手段的重要性，使抗高血压不依从性成为行为干预的主要目标。令人惊讶的是，在患有或不患有CKD的儿童中，没有关于抗高血压药物依从性的研究。医生与青少年的沟通是促进终身自我管理技能和改变的关键，因为青少年成熟了，承担了更多的照顾责任。然而，在我们对医生与青少年沟通的知识方面，特别是它如何影响治疗方案的依从性和健康结果，存在着显著的差距。通过一个全面的、纵向的慢性肾病青少年不依从预测模型来评估已知的风险和恢复因素以及医生与青少年之间的沟通是如何相互作用的，这是为高风险患者制定有效的、有针对性的依从性干预措施的重要前奏。本研究的目的是检验1)青少年抗高血压药物依从性对血压控制和CKD后续进展的影响；(2)医师与青少年沟通对药物依从性的影响。这是一项对150名年龄在11-19岁的CKD（1-5期）青少年进行的前瞻性研究，这些青少年服用了抗高血压药物。客观测量方法将用于评估抗高血压药物依从性（电子监测和药房补充），健康结果（例如，动态血压监测和CKD进展的生物标志物），以及医生与青少年的沟通（肾脏病门诊就诊的RIAS编码）。此外，我们还将评估已知的不依从性风险和弹性因素对医患沟通和依从性之间关系的调节作用。所有变量将在基线、12个月和24个月时测量；此外，将在6个月、18个月和30个月时测量依从性和健康结果。将使用纵向分析来模拟随时间变化的协变量的结果变化。这将使我们能够评估医生与青少年沟通的变化如何影响依从性，然后随后的血压控制和CKD进展。此外，从青少年CKD研究中获得的经验教训将有助于我们理解医生与青少年沟通对慢性疾病的影响。

DESCRIPTION (provided by applicant): Hypertension is one of the most important independent risk factors for chronic kidney disease (CKD) progression. The results of the recently completed ESCAPE trial highlight the importance of blood pressure control as a means to slow CKD progression, making antihypertensive nonadherence a prime target for behavioral intervention. Surprisingly, there is no research on adherence to antihypertensive medication among children either with or without CKD. Physician-adolescent communication is key for facilitating lifelong self-management skills and changes as the adolescent matures and assumes more responsibility for his/her care. However, there is a striking gap in our knowledge of physician-adolescent communication in general and specifically how it impacts regimen adherence and health outcomes. Evaluating how known risk and resilience factors and physician-adolescent communication interact through a comprehensive, longitudinal predictive model of adolescent nonadherence in CKD is an essential prelude to the development of effective, targeted adherence interventions for high-risk patients. The purpose of this study is to test 1) the impact of antihypertensive medication adherence in adolescents on blood pressure control and subsequent progression of CKD; and 2) the influence of physician-adolescent communication on medication adherence over time. This is a prospective study of 150 adolescents age 11-19 years old with CKD (Stages 1-5) who are prescribed an antihypertensive medication. Objective measurement approaches will be used to assess antihypertensive medication adherence (electronic monitoring and pharmacy refills), health outcomes (e.g., ambulatory blood pressure monitoring and biomarkers of CKD progression), and physician-adolescent communication (RIAS coding of nephrology clinic visits). Additionally, the moderating effect of known nonadherence risk and resilience factors on the association between physician-adolescent communication and adherence will be assessed. All variables will be measured at baseline, 12- and 24- months; additionally, adherence and health outcomes will be measured at 6-, 18- and 30-months. Longitudinal analyses will be used to model the change in outcomes with time-varying covariates. This will allow us to evaluate how changes in physician-adolescent communication impact adherence and then subsequent blood pressure control and CKD progression. Further, the lessons learned in this study of adolescents with CKD will add to our understanding of the impact of physician-adolescent communication across chronic illnesses.