A quality improvement intervention to decrease the decline in renal function in pediatric liver transplant recipients

被引:0
|
作者
Batsis, Irini [1 ,7 ]
Elisofon, Scott [2 ]
Ferguson, Michael [3 ]
Jonas, Maureen [2 ]
Kimball, Brendan [4 ]
Lee, Christine [2 ,5 ]
Mitchell, Paul
Fawaz, Rima [6 ]
机构
[1] Mt Sinai Kravis Childrens Hosp, Div Hepatol, New York, NY USA
[2] Harvard Med Sch, Boston Childrens Hosp, Div Gastroenterol Hepatol & Nutr, Boston, MA USA
[3] Harvard Med Sch, Boston Childrens Hosp, Div Pediat Nephrol, Boston, MA USA
[4] Boston Childrens Hosp, Pediat Transplant Ctr, Dept Qual Improvement, Boston, MA USA
[5] Harvard Med Sch, Boston Childrens Hosp, Inst Ctr Clin & Translat Res, Boston, MA USA
[6] Yale New Haven Childrens Hosp, Div Gastroenterol Hepatol & Nutr, New Haven, CT USA
[7] Mt Sinai Hosp, One Gustave L Levy Pl,Box 1104, New York, NY 10029 USA
关键词
eGFR; chronic kidney disease; pediatric liver transplantation; quality improvement; immunosuppression; GLOMERULAR-FILTRATION-RATE; OUTCOMES;
D O I
10.1111/petr.14506
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BackgroundChronic kidney disease (CKD) impacts long-term morbidity in pediatric liver transplant (LT) recipients. The prevalence of estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m(2) (eGFR < 90) at our institution was 25% at 1 year post-LT; thus, quality improvement (QI) project was initiated, aiming to decrease the prevalence of eGFR < 90 by at least 20% at 1 year-post LT. MethodsChildren post-LT under 19 years from 2010 to 2018 were included. Three QI interventions were implemented starting 1/2016: documentation of blood pressure percentile (BP%) and eGFR, documentation of a kidney management plan if either was abnormal, and amlodipine initiation prior to hospital discharge after LT. We compared the prevalence of eGFR < 90 at 3, 12, and 24 months after LT in the pre- and post-intervention period. Results68 patients in pre- and 42 in post-intervention periods met inclusion criteria. Pre-intervention BP%, eGFR, and kidney management plan were documented at 25%, 10%, and 22%, compared to 71%, 83%, and 71% post-intervention, respectively. 22% of patients were started on amlodipine prior to discharge from LT in the pre- versus 74% in the post-intervention period. Prevalence of eGFR < 90 at 3 m post-LT was 19% in pre- versus 14% in the post-intervention period (p = .31); at 12 months 24% versus 7% (p = .01) and at 24 months 16% versus 6% (p = .13), respectively. Significant non-modifiable risk factors for eGFR < 90 were malignancy (RR = 4.5, p < .0001), metabolic disorder (RR = 2.6, p = .02), and age at transplant (7% increased risk per year of age, p = .007). ConclusionBy improving documentation of BP%, eGFR, and kidney management plan, the prevalence of eGFR < 90 was decreased by a relative 74% and 60% at 12 and 24 months post-LT, respectively.
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页数:8
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