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Implementation of a standardized clinical pathway in a dedicated posterior urethral valves clinic: short-term outcomes.
- Source :
-
Pediatric Nephrology . Nov2023, Vol. 38 Issue 11, p3735-3744. 10p. 1 Color Photograph, 3 Diagrams, 2 Charts, 1 Graph. - Publication Year :
- 2023
-
Abstract
- Background: To determine if the implementation of a posterior urethral valves (PUV) clinic and standardized management pathway improves the short-term kidney outcomes of infants with PUV. Methods: From 2016–2022, 50 consecutive patients were divided into groups after the implementation of the clinic (APUV, n = 29) and before (BPUV, n = 21) during a comparable timeframe. Assessed data included age at initial visit, timing and type of surgery, frequency of follow-up visits, medications, nadir creatinine, and development of CKD/kidney failure. Data are shown as median with interquartile range (IQR) and odds ratios (OR) with 95% confidence interval (CI). Results: APUV had higher rates of prenatal diagnoses (12/29 vs. 1/21; p = 0.0037), earlier initial surgical intervention (8 days; IQR 0, 105 vs. 33 days; IQR 4, 603; p < 0.0001), and higher rates of primary diversions (10/29 vs. 0/21; p = 0.0028). Standardized management led to earlier initiation of alpha blockers (326 days; IQR 6, 860 vs. 991; IQR 149, 1634; p = 0.0019) and anticholinergics (57 days; IQR 3, 860 vs. 1283 days; IQR 477, 1718; p < 0.0001). Nadir creatinine was reached at earlier ages in APUV (105 days; IQR 2, 303 vs. 164 days; IQR 21, 447; p = 0.0192 BPUV). One patient progressed to CKD5 in APUV compared to CKD3, CKD5 and one transplant in BPUV. Conclusion: Implementing the PUV clinic with standardized treatment expedited postnatal management and resulted in a higher number of cases detected prenatally, a shift in primary treatment, younger ages at initial treatment, reduced time to nadir creatinine, and timely initiation of supportive medications. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CHRONIC kidney failure
*ADRENERGIC alpha blockers
*PARASYMPATHOMIMETIC agents
*CONFIDENCE intervals
*AGE distribution
*TIME
*FISHER exact test
*MANN Whitney U Test
*MEDICAL protocols
*HUMAN services programs
*TREATMENT effectiveness
*PEARSON correlation (Statistics)
*T-test (Statistics)
*DESCRIPTIVE statistics
*ODDS ratio
*DATA analysis software
*CREATININE
*CHILDREN
URETHRAL obstruction
Subjects
Details
- Language :
- English
- ISSN :
- 0931041X
- Volume :
- 38
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Pediatric Nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 172285028
- Full Text :
- https://doi.org/10.1007/s00467-023-06040-7