1697 Five years of thinking kidneys: reviewing paediatric AKI services

BackgroundIt has been five years since the ‘Think Kidney’s’ campaign to improve recognition and management of acute kidney injury (AKI). Whilst there have been rapid advances in AKI services in adult medicine, the progress in paediatricst has been much slower and there continue to be shortcomings despite pre-existing electronic AKI alerts. Population disease burden from paediatric AKI is difficult to quantify but patients do experience morbidity from nephrological and cardiological disease.ObjectivesWe reviewed paediatric AKI practice in a tertiary hospital catchment area and surveyed trainee awareness of AKI.MethodsWe surveyed paediatric trainees in a large tertiary centre to assess awareness of the AKI guidance and practices. We also undertook a retrospective review of all patients admitted to paediatric intensive care unit (PICU) with AKI between February 2019 and February 2020. A further AKI survey was sent to nephrology-link paediatricians (NLP’s) at district general hospitals (DGH’s) in our region.Results29 paediatric trainees from eleven subspecialities were surveyed. 35% were unaware of the hospital AKI guideline. 83% reported that a care bundle for AKI management is not used in their department. 66% reported that AKI was discussed at ward round and huddle’s and 93% reported that AKI was highlighted on discharge summaries. 39% reported that patients experiencing AKI 3 are not routinely discussed with nephrology and 62% reported that patients with AKI are not routinely referred to nephrology for follow-up. 93% of trainees were unsure if patients with proteinuria or persistently reduced renal function 3 months after AKI were referred to nephrology for follow-up. LCH PICU data revealed 96 patient episodes of AKI over the year. The majority of AKI followed cardiac surgery and sepsis. 46% had AKI stage 3 and 31% received peritoneal dialysis or haemofiltration. 10% were discussed with nephrology and 3% were referred to nephrology for follow-up at discharge. 8 DGH’s responded to our survey. 87.5% do not have a local guideline for the management of paediatric AKI and 75% do not specifically highlight AKI at ward round or handover. All centres discuss patients with AKI stage 2 and 3 with NLP’s or tertiary nephrologists, and 50% of centres refer patients for follow-up upon discharge. 65% of centres record AKI on the patient discharge summary.ConclusionsOur findings have demonstrated deficiencies in awareness and delivery of AKI services across the catchment area of a large tertiary hospital in England. Children with AKI 3 did not receive specialist nephrology care. A training need was identified in paediatric junior doctors. We suspect these issues are not limited to our region. This highlights the need for a more robust follow-up pathway for AKI in paediatrics. The lack of trainee knowledge emphasises the need to deliver an AKI educational programme, possibly at the level of the Royal College or included in the trainee curriculum. We hope that we will be able to roll out, in addition to existing digital alerts, a STOP AKI Care Bundle that will trigger a response to the AKI alert and improve follow-up.