National Practice Patterns in the Care of Pediatric AKI Survivors
Bibliographic record
Abstract
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 optimize post-AKI care. In this study, we surveyed pediatric nephrologists to determine their practice patterns in the care of AKI survivors. Methods: We administered an email survey to members of the Pediatric Nephrology Research Consortium (PNRC) throughout the US & Canada. Participants were asked questions regarding their practice characteristics, frequency of care of post-hospital AKI survivors and perceptions regarding provider roles in post-AKI outpatient care. Participants were also asked questions regarding the content of their AKI care, patient counseling and disease monitoring. Results: Of the 52 respondents, most practiced in an academic setting (96%) for <20 years (83%) and reported caring for >10 AKI survivors each year (69%). The majority of respondents (64%) felt pediatric nephrology should always be involved in AKI follow-up care; 33% felt only for ≥ Stage 2 AKI. Most (73%) felt nephrology care was no longer needed when clinical concerns resolved; 60% when eGFR returns to normal; 46% when urine protein/creatinine (UPC) ratio is normal. Most respondents listed professional conferences (79%) and peer-reviewed articles (87%) as information sources. For mild AKI, 60% of participants repeated a creatinine test after 1 month following discharge; 25% reported checking within 1 week of discharge. In severe AKI, tests were repeated within 1 week (67%). Most reported measuring blood pressure, serum creatinine & UPC at follow-up (>90%). Respondents endorsed counseling patients on risk of recurrent AKI (69%), incident hypertension (92%), incident CKD (81%) and NSAID avoidance (85%). Overall, 90% of respondents felt comfortable managing AKI follow-up in pediatric patients. Conclusions: Pediatric nephrologists were generally confident in their ability to counsel and manage pediatric AKI survivors. Most felt AKI care required pediatric nephrology input and reported providing education about AKI consequences. Whether primary care providers endorse similar confidence and co-management perceptions requires further study. Funding: Other NIH Support - This work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R38HL143612
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".