{"doi":"10.34067/kid.0000000593","title":"The Landscape of Pediatric Acute Care Nephrology Programs","abstract":"Introduction The past 20 years of research have defined the epidemiological burden and deleterious effect of AKI and fluid overload, clearly showing their independent contribution to increased morbidity and mortality in critically ill neonates and children.1–3 Renal replacement therapy (RRT), including peritoneal dialysis, intermittent hemodialysis, and continuous RRT (CRRT), is often required for the most severe cases of AKI, with increasing use of Carpediem (Mozarc Medical, Minneapolis) and Aquadex (Nuwellis Inc, Minneapolis) in the neonatal population.4–6 These advances in RRT modalities, combined with the challenges of providing multidisciplinary care for medically complex patients, have resulted in a rapidly growing need for critical care nephrology expertise and support across pediatric, neonatal, and cardiac intensive care units. Understanding the structure of hospital teams and programs to support pediatric-specific aspects of delivering high-quality RRT was recently identified as a critical knowledge gap by the 26th Acute Disease Quality Initiative Consensus Conference.7 As institutions have increasingly developed and implemented such dedicated programs, the number of patients, complexity of therapies, and number of available devices have expanded, further heightening the need for structured leadership, education, standardized practices, and quality improvement (QI) programs. While previous reports have explored such practices in adults and resource-limited settings, there remains a paucity of data on the current programmatic support for pediatric and neonatal CRRT. To address this gap, the Acute Care Nephrology (ACN) Interest Group within the American Society of Pediatric Nephrology surveyed high-volume, pediatric institutions across the United States to define current practices developed by individual hospitals/programs, including available infrastructure, resources, and nursing models in supporting the delivery of pediatric acute RRT. Methods The survey was developed by a multidisciplinary team of physicians, advanced practice providers, and nurses and included questions evaluating programmatic structure, support, therapies provided, volume of procedures, QI, and educational practices (Supplemental Material). The questions were reviewed and refined through an iterative process. Here, we defined an ACN program as a “dedicated program with leadership/resources, directed at overseeing the delivery of acute RRT, and focused on critical care nephrology and/or intensive care unit patients.” The final survey was approved by the Institutional Review Board at UT Southwestern Medical Center (STU-2023-0102) with waiver of consent. It was electronically distributed to the division directors of the top 50 pediatric nephrology centers in the US News and World Report Best Children's Hospital 2023. These centers were selected with the goal of reaching high-volume pediatric nephrology centers. The survey could be answered by the division director or their designee. Study data were collected and managed using Research Electronic Data Capture tools hosted at UT Southwestern Medical Center. Data are presented as median (interquartile range) and number (%). Center volumes were reported by total CRRT days in the previous year. Basic statistical analyses comparing centers by volume were performed using R 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). Results A total of 47 of the 50 eligible centers (94%) completed the survey. Of those, 37 (79%) respondents reported having a dedicated ACN program (Table 1). The ACN program is jointly managed within the chronic dialysis program in 25/37 (68%). Notably, 32 (86%) of the ACN programs have a medical director with a median (interquartile range) full-time equivalent (FTE) of 10% (5, 20%) dedicated to this role, while 6 (19%) programs have no protected effort for the medical director. Twenty-one (57%) of ACN programs have an ACN nursing director. Other available personnel in suc","journal":"Kidney360","year":2024,"id":481572,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.96,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":486344,"name":"Shina Menon","orcid":"0000-0001-8473-0307","position":1,"is_corresponding":false},{"id":1209352,"name":"Kara Short","orcid":null,"position":2,"is_corresponding":false},{"id":1321987,"name":"Katie Plomaritas","orcid":null,"position":3,"is_corresponding":false},{"id":1321579,"name":"Brendan Crawford","orcid":"0000-0002-7405-8569","position":4,"is_corresponding":false},{"id":1208850,"name":"Kyle Merrill","orcid":"0000-0001-8238-7939","position":5,"is_corresponding":false},{"id":1321580,"name":"Alyssa A. Riley","orcid":"0000-0001-5113-0751","position":6,"is_corresponding":false},{"id":802774,"name":"Weiwen V. Shih","orcid":"0000-0002-0076-0697","position":7,"is_corresponding":false},{"id":336745,"name":"David J. Askenazi","orcid":"0000-0002-6840-9887","position":8,"is_corresponding":false},{"id":454565,"name":"David T. Selewski","orcid":"0000-0003-0358-0760","position":9,"is_corresponding":false},{"id":1321988,"name":"on behalf of the American Society for Pediatric Nephrology (ASPN) Acute Care Nephrology Interest Group","orcid":null,"position":10,"is_corresponding":false},{"id":244960,"name":"Keri A. Drake","orcid":"0000-0002-9355-5202","position":0,"is_corresponding":true}],"reference_count":14,"raw_metadata":null,"created_at":"2026-07-19T02:07:10.067421Z","pmid":"39752241","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}