For the first time in its history, a consensus statement from the Acute Disease Quality Initiative (ADQI) co-authored by Cincinnati Children’s physicians will focus solely on acute kidney disease in children. The statement was published in JAMA Network Open, which has the highest impact of any ADQI publication, and is an international, peer-reviewed, open access, general medical journal from the American Medical Association.

“For a pediatric consensus document to be published in a journal with such impact and worldwide reach is unprecedented,” says Stuart Goldstein, MD, FAAP, director of the Center for Acute Care Nephrology.

A True International Community Effort

Physician, nurse, dietitian and pharmacologist clinician researchers developed 12 consensus statements and 29 research recommendations at the 26th ADQI meeting in November 2021. More than one-quarter of those who participated are current Cincinnati Children’s faculty, past fellows or mentees of Goldstein.

The panel focused on six areas:

       1.  Biology, pharmacology and nutrition.

       2.  Diagnostics

       3.  Education and advocacy.

       4.  Epidemiology

       5.  Fluid overload

       6.  Kidney support therapies

The primary recommendations from the pediatric ADQI meeting to address gaps of knowledge are to:

• Adjudicate fluid balance by disease severity.

• Broaden definitions of AKI phenotypes.

• Include data from varying socioeconomic groups.

• Integrate biopathology of child growth and development.

• Partner with communities and families in AKI advocacy.

Continuous Improvement for AKI Diagnosis and Care

The ADQI formed in 2000 to provide an ongoing assessment of the current state of practice and to improve patient care through evidenced-based medicine for acute kidney injury and other conditions requiring dialysis. The international group represents leading universities worldwide and sets new standards for the diagnosis and management of acute kidney injury and related disorders.

“ADQI proposes and then addresses the critical questions in the field,” Goldstein says. “The most important aspect is to identify current gaps and develop research recommendations for moving forward.”

What starts at an ADQI meeting often leads to worldwide change, such as the first unified definition of acute kidney injury.

“If you can’t define it, you can’t address or improve it,” Goldstein says.

The definition was tested in multiple adult populations. In 2007, it was refined for children. Based on ADQI’s work, KDIGO—a global nonprofit that develops and implements clinical practice guidelines for kidney disease—created the first international guidelines for acute kidney injury in 2012.

The collaborative work at ADQI meetings transforms the field.

“Information is distilled, gaps are identified, research recommendations are put forward and then those recommendations are acted upon,” Goldstein says.

Other concepts fleshed out at ADQI include:

• Classifying and staging cardiorenal syndrome

• Consideration of biomarkers for predictive diagnosis

Most ADQI meetings include pediatric professionals, but not always. Sometimes the topic is not relevant. When it is, the group is receptive to pediatric input. What’s known today about AKI is thanks in part to seminal work and research in pediatrics.

A Meeting of ‘Firsts’

The November 2021 ADQI was the group’s first devoted to children.

“We now have enough data and questions answered that we felt it was time to propose research priorities to move the needle again,” Goldstein says.

Forty of the 46 attendees were first-time participants. All have contributed novel insights to the field. The group was evenly split among men and women.

The conference also included ADQI’s first patient perspective. One of Goldstein’s former patients (who is now a recent college graduate) kicked off the meeting. At age 7, this patient was treated with acute dialysis to manage disseminated sepsis and multiorgan failure. Another first—a former Cincinnati Children’s nephrology fellow who now works at Nationwide Children’s Hospital as an expert in social determinants of health also participated.

The patient and social determinants of health expert attended all six focus area sessions to ensure the patient and socioeconomic perspectives were included.

“What’s great and unique about the pediatric nephrology community is our collaborative spirit. It was also personally gratifying to have many former fellows and junior faculty whom I mentored being there, doing their own independent work to advance the field. It is their contributions that have gotten us to a point where a pediatric ADQI conference is warranted and needed,” Goldstein says.

This pediatric ADQI conference’s work is not done. The six work groups have submitted a compendium of individual manuscripts that delve into the details of each topic more specifically.