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Nephrology and Hypertension

Significant Accomplishments

Center for Acute Care Nephrology

The incidence of acute kidney injury has reached epidemic proportions globally, afflicting one third of critically ill children and often resulting in death or chronic kidney disease. The urgent need to develop optimal care for patients with or at risk for acute kidney injury led us to launch the Center for Acute Care Nephrology (CACN).The collaboration among Nephrology, the Heart Institute and Critical Care had a stellar first year. Our clinical accomplishments include launching the first in-house consultative acute Pheresis Service in February 2011 and implementation of proactive peritoneal dialysis in children at risk for acute kidney injury after cardiac surgery. These initiatives have dramatically improved outcomes for children as they receive state-of-the-art care without complications.

In addition, the CACN spearheaded a collaboration with the James M. Anderson Center for Health Systems Excellence to implement an institution-wide initiative to reduce nephrotoxic medication-associated kidney injury. On the research side, the CACN secured more than $350,000 in extramural funding. One pioneering project involves using the novel biomarker NGAL to direct institution of early treatments in critically ill children.

Kidney Transplant Center

The multidisciplinary Kidney Transplant Center has performed nearly 500 kidney transplants in children since 1965. Our mission is to optimize the quality of life of children suffering from chronic kidney disease by providing the foremost clinical care, education and research pertaining to pediatric kidney transplantation. Recent years have seen many advances, thanks to novel protocols that optimize the care of children with the most complex malformations, antibody-mediated rejection and BK virus nephropathy. Despite the complexity, our kidney transplant program continues to achieve patient and graft survival rates at or above the national benchmarks, while the lengths of stay for the initial transplant surgery are shorter than the national average. These successes have established our program as one of the premier transplant centers in the Midwest, and more than half of our patients come from distant cities and states. During 2011, we performed 21 kidney transplants, which places us within the top five busiest pediatric kidney transplant centers in the country. These achievements are fueled by ongoing funded research aimed at improving these outcomes, with focus areas in immunology, adherence and quality improvement.

Dialysis Unit

The Dialysis Unit is the second largest in the Midwest and among the 10 largest in the country. By far the most challenging and complex dialysis patients are infants. Over the past decade, we cared for only one infant on home dialysis. Over the past 18 months, this demanding population has soared, and we now care for seven infants on home dialysis. Most infants have come from outside the Cincinnati area, many referred via our Fetal Care Program because of lack of complex dialysis expertise at their home institutions. The care of these infants is optimized through a coordination of services orchestrated by the dialysis unit, bringing together their medical, surgical, nutritional, developmental and psychosocial needs. New policies for aggressive feeding, hormonal and dialytic treatments have resulted in improved physical and mental development, and earlier kidney transplantation. Such initiatives have assured optimal care and set best practice care standards for this unique dialysis population.