University at Buffalo Researchers Find Most Pediatric ICU Physicians Don’t Use Current Guidelines to Diagnose Acute Kidney Injury

Published November 17, 2016

A study by University at Buffalo researchers shows that physicians in pediatric intensive care units are not using the newest guidelines to diagnose acute kidney injury (AKI) in critically ill children, a practice that could affect their patients’ long-term health.

UB School of Public Health and Health Professions alumna and pediatric critical care physician who focuses on acute kidney injury, Dr. Amanda Hassinger, surveyed colleagues in her field on practice patterns related to the diagnosis and treatment of AKI, a condition that affects about 15 percent of critically ill children.  The prevalence of AKI among patients in pediatric intensive care units is on the rise, which, she says, lends more urgency to gauging the current state of AKI management in pediatric intensive care units (PICUs). The results were discouraging, Dr. Hassinger reports in a recent paper in the journal Pediatric Critical Care Medicine.

“What we found was pretty surprising. It was scarier than I thought in terms of how aware other physicians in my field are to the new guidelines for treatment of AKI and the new methods to diagnosis earlier and more effectively,” said Dr. Hassinger, lead author on the paper, published in the journal’s August issue.

She wrote it while working on her master’s degree in epidemiology/clinical research in UB’s School of Public Health and Health Professions. Dr. Hassinger has been an attending physician in the Division of Critical Care at Women & Children’s Hospital of Buffalo, and is also an assistant professor of pediatrics in UB’s Jacobs School of Medicine and Biomedical Sciences and a member of UBMD Pediatrics.

Dr. Hassinger and her co-authors surveyed 170 pediatric critical care physicians from academic centers, the Pediatric Acute Lung Injury and Sepsis Investigators network and the pediatric branch of the Society of Critical Care Medicine.  The survey consisted of more than two-dozen questions. Among them, researchers asked what criteria the physicians frequently rely on to diagnose acute kidney injury in young patients. Half of the respondents reported not using recent AKI guidelines or diagnostic criteria in clinical practice. Specifically, 74 percent of physicians said they diagnose AKI using serum creatinine and urine output only, despite the fact that newer, more reliable, tests are available.

The problem with serum creatinine as a test for renal function, Dr. Hassinger says, is that it is not effective in children for detecting AKI. It can be affected by several other factors, including nutrition and muscle mass. Several new biomarkers have been discovered that aid in the diagnosis of AKI.

“This study gives us an important picture of what practice looks like in pediatric ICUs, so that we can understand what is missing,” said Dr. Jo Freudenheim, UB Distinguished Professor and chair of the department of epidemiology and environmental health in UB’s School of Public Health and Health Professions, and a co-author on the paper. “We can now start to make renewed efforts to change practice and to improve care.”

Other investigators on the paper are Dr. Sudha Garimella, clinical assistant professor in the department of pediatrics in UB’s Jacobs School of Medicine and Biomedical Sciences and medical director of the Pediatric Dialysis Unit at Women & Children’s Hospital of Buffalo, and Dr. Brian Wrotniak of the department of pediatrics.