1. A quality improvement intervention to decrease the decline in renal function in pediatric liver transplant recipients.
- Author
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Batsis, Irini, Elisofon, Scott, Ferguson, Michael, Jonas, Maureen, Kimball, Brendan, Lee, Christine, Mitchell, Paul, and Fawaz, Rima
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LIVER transplantation , *KIDNEY physiology , *METABOLIC disorders , *CHRONIC kidney failure , *GLOMERULAR filtration rate , *EPIDERMAL growth factor receptors - Abstract
Background: Chronic 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 m2 (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. Methods: Children 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. Results: 68 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). Conclusion: By 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. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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