In the U.S. population, both decreased eGFR and elevated systolic BP occur frequently among adolescents with history of LBW/VLBW.

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Background: Experimental evidence suggests that hyperosmolality may be a causative factor in the development of both salt-sensitive hypertension and chronic kidney disease (CKD). There are no population-wide studies in young persons to assess the relationships among these factors. Objective: To determine the association of serum osmolality and serum sodium with high systolic blood pressure (SBP) and decreased estimated glomerular filtration rate (eGFR) among a nationally representative population of adolescents. Method: Relevant data among participants ages 12–14 were obtained from the National Health and Nutrition Examination Survey cycles 1999–2012. Serum osmolality was calculated using the Worthley equation. eGFR was calculated using the Counahan-Barratt equation, and values < 90 mL/min/1.73 m² were considered decreased. High SBP was defined as SBP ≥95th percentile for age, height, and sex. Results: A total of 4,168 adolescents were analyzed (representative population: 10,464,592). Adolescents with serum osmolality ≥290 mOsm/kg and/or serum sodium ≥143 mmol/L had increased odds for both high SBP (serum osmolality ≥290 mOsm/kg: OR 2.04; 95% CI 1.03–4.02; sodium ≥143 mmol/L: OR 4.36; 95% CI 1.58–12.04) and decreased eGFR (serum osmolality ≥290 mOsm/kg: OR 1.61; 95% CI 1.18–2.21; sodium ≥143 mmol/L: OR 3.27; 95% CI 1.77–6.03) when compared to participants with values below these thresholds. These thresholds remained significant even after multivariable adjustment. Conclusion: Among adolescents in a nationally representative survey, hypernatremia and hyperosmolality were associated with high SBP and decreased eGFR. These findings may support the hypothesis that an imbalance of salt and water contribute to hypertension and CKD.

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BACKGROUND AND OBJECTIVES Graduated autonomy is fundamental as trainees transition to independent practice. Family-centered rounds (FCR), the leading model of inpatient rounding in pediatrics, is an opportunity for trainees to demonstrate their competence in leading a health care team, which is an entrustable professional activity for all pediatric residents. At our institution, senior residents (SRs) at baseline performed at a novice level on the basis of the Senior Resident Empowerment Actions 21 (SREA-21), a validated tool that is used to assess SR autonomy during FCR. Our objective for this study was to increase the median percentage of SREA-21 domains in which SRs perform at a competent level from 38% to 75% within 6 months. METHODS Researchers observed 4 FCR encounters weekly and calculated SREA-21 scores after 2 weeks on the basis of actions promoting SR autonomy performed by the SR-hospitalist dyad. The primary outcome measure was the percentage of SREA-21 domains in which the SR achieved a competent score on the SREA-21. We used the model for improvement to identify key drivers and test proposed interventions using serial plan-do-study-act cycles. Interventions included creation of unified inpatient SR expectations, introduction of a SR-hospitalist pre-FCR huddle, auditing of FCR interruptions, and direct feedback to the SR-hospitalist dyad after FCR. Run charts were used to track SR and hospitalist scores on the SREA-21. RESULTS After multiple plan-do-study-act cycles, there was special cause improvement with a desirable shift upward in the centerline to 100%, which correlated with the project’s interventions and surpassed our goal. CONCLUSIONS Using quality improvement methodology, we improved SR autonomy during FCR, as measured by the SREA-21.