The Center for Acute Care Nephrology (CACN) at Cincinnati Children’s was the first and remains one of only two pediatric centers in the country to monitor and identify early the conditions that put children at risk for acute kidney injury (AKI).

“We collaborate across the enterprise to assess and reduce risk, standardize interventions and bring novel therapies to all other services who may have patients with, or at risk for, AKI,” says CACN Director Stuart Goldstein, MD, FAAP, FNKF.

Under Goldstein’s leadership, the CACN has had a significant impact on identifying and reducing AKI in the hospital by following a simple principle: using existing mechanisms such as the hospital’s electronic health record (EHR) to build in systematic screening for, and alerts about, young patients at risk. 

One such systematic screening, Nephrotoxic Injury Negated by Just-in-time Action (NINJA), showed a remarkable reduction in AKI from nephrotoxic medication exposures. Systematic review of the EHR identified patients on nephrotoxic medications and recommended regular creatinine screening. Among the 1,749 patients included in the study, nephrotoxic medication exposure rate decreased by 38 percent and AKI rates decreased by 64 percent.

In 2016, Goldstein and his colleagues published a report in Kidney International demonstrating the sustainability of this screening project. Five years after implementing the screening, the program is still going strong, and continues to identify and reduce the incidence of AKI.

Goldstein attributes this success to the hospital’s commitment to supporting the endeavor, which he noted in the published report.

“Sustainability can only be achieved with reliable systems that become part of the organizational culture,” he wrote. “Once the early NINJA results were shared with hospital physicians and administrative leadership, we were supported to develop reliable automated processes to identify patients, incorporate education into rounds, and to empower pharmacists to make screening and nephrotoxic medication adjustment recommendations.

The CACN’s achievements add to an already robust program of research by the Division of Nephrology and Hypertension at Cincinnati Children’s. The division has already produced a rapid test for AKI, allowing doctors to move quickly to prevent or lessen damage to the kidney.

In another report published 2017 in JAMA Pediatrics, doctors in the CACN and the Heart Institute evaluated and reported on the safety of peritoneal dialysis to reduce fluid overload and the effects of AKI in infants following heart surgery.

Most recently, the CACN published findings from a 32-center international study in the January 5, 2017, New England Journal of Medicine, finding that nearly 27 percent of children admitted to hospital ICUs – no matter the diagnosis – develop AKI while in hospital – often within the first four days of admission. The study underscores the importance of building regular urine testing or creatinine level testing into hospital systems.

Despite the success the CACN has had in helping prevent AKI at Cincinnati Children’s, Goldstein continues to look for ways to build additional safety measures into existing systems. “We are working to integrate risk stratification and biomarkers results into clinical decision support to personalize care for critically ill children at risk for acute kidney injury, both locally and nationally."