Fellow Duke University School of Medicine 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 inform the content and frequency of post-AKI care. In this study, we surveyed general pediatric providers to characterize outpatient practice patterns in the care of hospital AKI survivors. Objective: To characterize pediatric AKI outpatient practice patterns Design/Methods: We administered an online survey to general pediatric providers across the US and concentrated at an academic medical center in the Southeast US. We assessed participant practice characteristics and frequency of providing post-hospital AKI care. Participants were asked to describe the content of the AKI care provided, including disease monitoring and patient counseling. Finally, providers were asked about perceptions regarding provider roles in post-AKI outpatient care, including nephrology co-management and their overall comfort managing outpatient AKI care. Results: Of the 36 survey respondents, most practiced in an academic setting (62%) and cared for 1-5 AKI survivors each year (47%). For patients with mild AKI, 33% of providers repeated a creatinine test after 1 month following discharge; 41% reported checking within 1 week of discharge. In severe AKI, tests were similarly repeated within 1 week (39%). During follow-up visits, most providers reported measuring blood pressure, serum creatinine, and urinalysis (>80%) and counseling patients on risk of incident hypertension (50%) and NSAID avoidance (75%). Most providers reported utilizing medical databases (61%) and nephrology consultation (61%) to guide AKI follow-up. Nearly half of respondents (47%) felt pediatric nephrology should always be involved in AKI follow-up care while 33% felt only for ≥ Stage 2 AKI. Half (52%) felt nephrology care was no longer needed when clinical concerns resolved; 52% when eGFR returned to normal; 44% when urine protein/creatinine (UPC) ratio was normal. Overall, only 36% of providers felt comfortable managing outpatient AKI follow-up in pediatric patients.
Conclusion(s): General pediatrics providers report caring for few pediatric AKI survivors per year and consequently, few endorse comfort in their overall ability to manage pediatric AKI survivors. Need for pediatric nephrology involvement and content of co-management varied. Therefore, standardized AKI follow-up guidelines and recommendations for nephrology co-management may improve the adverse outcomes associated with pediatric AKI.
