Kidney Week

Abstract: PO2304

Improving Metabolic Acidosis in Patients with CKD

Session Information

• Pediatric Nephrology: Benign Urology, AKI, Neonatal Nephrology, and Case Reports
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1700 Pediatric Nephrology

Authors

• Morgans, Heather, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

Heather Morgans,

• Gregg, Gina, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

Gina Gregg,

• Cisneros, Rachel A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

Rachel A. Cisneros,

• El Feghaly, Rana E., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

Rana E. El Feghaly,

• Weidemann, Darcy K., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

Darcy K. Weidemann,

Background

Pediatric chronic kidney disease (CKD) is characterized by multiple metabolic derangements including metabolic acidosis. Untreated acidosis is associated with bone disease, increased mortality, and CKD progression^1,2. Current guidelines recommend bicarbonate supplementation for CKD patients with serum bicarbonate < 22mmol/L³. Review of our nephrology division’s clinical practice in the past year found that 36% of patients with CKD stage 3-5 were acidotic, although only 25% of these received an intervention to address the acidosis. Our aim is to increase the percentage of interventions for acidosis in this population from 25% to 50% by June 30, 2020.

Methods

Monthly reports were generated for patients with CKD stage 3-5 and acidosis in the nephrology clinic. Our outcome measure is the percentage of acidotic patients. Process measures include the percentage of acidosis recognition, appropriate intervention, and patients on bicarbonate treatment. The balancing measure is patients with alkalosis (bicarbonate > 28mmol/L) while on supplementation. A multidisciplinary team identified multiple root causes and baseline data identified that lack of provider recognition of mild acidosis (bicarbonate 20-22) was the primary driver why treatment was not initiated. Countermeasures were developed to address this gap.

Results

Using PDSA cycles, we have implemented 2 countermeasures. Initially, we utilized provider directed feedback to notify those who had patients with untreated acidosis in the past month. Then, an education session was completed in March 2020. Our goal of increasing interventions for acidosis to 50% was exceeded by March 2020 (75%). There was also decrease in the number of acidotic patients, increase in provider recognition and bicarbonate treatment, with no increase in patients with alkalosis (Figure 1).

Conclusion

Utilizing provider directed feedback along with educational sessions have effectively increased the percentage of CKD stage 3-5 patients who are appropriately treated for acidosis. Further interventions are ongoing.