LAS VEGAS — An acute kidney injury follow-up pathway developed at the Cincinnati Children’s Center for Acute Care Nephrology (CACN) increased three-month follow-up rates above the national average for both pediatric and adult patients.

Early data indicate that 65% of patients who entered the pathway made it to the three-month visit, according to a poster presented at the National Association of Pediatric Nurse Practitioners 2015 meeting.

“Pediatric nurse practitioners and clinicians are in a unique position to manage the survivors of AKI — a diagnosis associated with increased morbidity, risk for chronic kidney disease, and an independent predictor of mortality,” said Elizabeth Rompies, MSN, CNP, APRN, an education specialist at the center.

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The pathway improved upon the CACN’s existing ad-hoc AKI follow-up service with a trigger report to identify patients in need of services. The daily alert reported patients with creatinine >1.5 times baseline (at least 0.5), patients who met any/all pediatric RIFLE criteria, and those receiving nephrotoxic medications or aminoglycosides.

Patients who met inclusion criteria for follow-up were then entered into a tracking spreadsheet along with information about their primary service, CKD stages and adherence notes. The center coordinated with primary providers, patients and parents via email, phone calls, and a standard letter.

Once entered into the AKI follow-up pathway, patients were educated about the causes, treatments, and resources available, and received a laminated wallet card listing both over-the-counter and prescribed nephrotoxins.

“We’ve received positive feedback from parents and families surrounding our educational materials, and the ease with which they are able to schedule follow-up appointments,” Rompies said.

As more patients are recruited into the AKI follow-up pathway, clinicians at CNAC hope to see decreases in the number of loss to follow up cases, higher enrollment rates, and better adherence to principal time points for monitoring.

“I hope to see the establishment of palpable level of trust within not only our population, but the primary clinicians of these patients,” Rompies said. “In a disease which may often carry little to no symptoms, trust in one’s provider may be the only feeling patients and families can measure.”


  1. Rompies E. #TH-32. “Building an acute kidney injury follow-up clinic – the unique role of a pediatric nurse practitioner.” Presented at: NAPNAP 2015. March 11-14, 2015; Las Vegas.