1 - Acute renal replacement therapy (RRT) in pediatric patients: a national survey assessing programmatic delivery of care

Poster Number: 1
Publication Number: 1.1862

Background: Acute kidney injury occurs commonly in critically ill children and is associated with significant morbidity and mortality. Advances in pediatric renal replacement therapy (RRT) technology, along with the challenges of providing multidisciplinary care for medically complex patients, have led to an increased need for critical care nephrology expertise and support across pediatric, neonatal, and cardiac intensive care units (ICUs). In response to these growing needs, individual children’s hospitals have implemented Acute Care Nephrology (ACN) programs to improve the delivery of safe, timely, and effective evidence-based care for children with AKI and other non-renal conditions that can benefit from RRT.

Objective: Given inherent variations in practices, resources, and RRT modalities from physician, nursing, and infrastructure perspectives, we aimed to evaluate current practices of ACN programs across the United States (US).

Design/Methods: An electronic survey was distributed to the top 50 pediatric nephrology programs from the US News & World Report Best Children's Hospitals 2023 ranking. Questions included details of programmatic structure, therapies provided, volume of procedures, quality improvement (QI), and educational practices.

Results: 47 centers (94%) completed the survey, with Table 1 showing selected results by center volume. Overall, 79% of respondents have a dedicated ACN program, with 53% jointly managed within their chronic dialysis program. 68% have a medical director with a median (IQR) full time equivalent (FTE) of 10% (5, 20%), though 13% (6 programs) report 0 FTE. Only 45% have an ACN nursing director. Other available personnel include nurse educator (53%), program administrator (17%), advanced practice provider (13%), and QI specialist (21%). ACN focused QI programs are present in only 40%, with an additional 34% of centers collecting some metrics related to patients, circuits, and access, while 36% do not track any data. The most common barriers for implementing QI programs include lack of protected time, resources, and support from leadership. Despite variability in program size, structure, and modalities offered, 81% of responding centers identified a need for increased medical director FTE, and 90% identified a need for increased nursing director FTE (Figure 1).

Conclusion(s): This data provides a first-of-its-kind description of the current structure/delivery of care in pediatric ACN practices from hospitals across the US and identifies potential areas for systematic improvement in the delivery, monitoring, and comprehensive approach to pediatric acute RRT.