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Kidney Week

Abstract: PO0178

National Practice Patterns in the Care of Pediatric AKI Survivors

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Williams, Anna E., Duke University Hospital, Durham, North Carolina, United States
  • Burks, Erin E., Duke University Hospital, Durham, North Carolina, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Gbadegesin, Rasheed A., Duke University Hospital, Durham, North Carolina, United States
  • Diamantidis, Clarissa Jonas, Duke University Hospital, Durham, North Carolina, United States
Background

Acute kidney injury (AKI) affects 5-10% of all children admitted to the hospital and is associated with adverse outcomes such as increased risk of recurrent AKI, incident and progressive chronic kidney disease (CKD) and death. However, few guidelines exist to optimize post-AKI care. In this study, we surveyed pediatric nephrologists to determine their practice patterns in the care of AKI survivors.

Methods

We administered an email survey to members of the Pediatric Nephrology Research Consortium (PNRC) throughout the US & Canada. Participants were asked questions regarding their practice characteristics, frequency of care of post-hospital AKI survivors and perceptions regarding provider roles in post-AKI outpatient care. Participants were also asked questions regarding the content of their AKI care, patient counseling and disease monitoring.

Results

Of the 52 respondents, most practiced in an academic setting (96%) for <20 years (83%) and reported caring for >10 AKI survivors each year (69%). The majority of respondents (64%) felt pediatric nephrology should always be involved in AKI follow-up care; 33% felt only for ≥ Stage 2 AKI. Most (73%) felt nephrology care was no longer needed when clinical concerns resolved; 60% when eGFR returns to normal; 46% when urine protein/creatinine (UPC) ratio is normal. Most respondents listed professional conferences (79%) and peer-reviewed articles (87%) as information sources. For mild AKI, 60% of participants repeated a creatinine test after 1 month following discharge; 25% reported checking within 1 week of discharge. In severe AKI, tests were repeated within 1 week (67%). Most reported measuring blood pressure, serum creatinine & UPC at follow-up (>90%). Respondents endorsed counseling patients on risk of recurrent AKI (69%), incident hypertension (92%), incident CKD (81%) and NSAID avoidance (85%). Overall, 90% of respondents felt comfortable managing AKI follow-up in pediatric patients.

Conclusion

Pediatric nephrologists were generally confident in their ability to counsel and manage pediatric AKI survivors. Most felt AKI care required pediatric nephrology input and reported providing education about AKI consequences. Whether primary care providers endorse similar confidence and co-management perceptions requires further study.

Funding

  • Other NIH Support