Novel programs and drive to improve patient care elevate pediatric nephrology program

NICU surveillance that captures all neonates with AKI

A novel multidisciplinary Pediatric Kidney Transplant Transition Program

Virtual start initiative that quadrupled the rate of inpatient CRRT

With these among its accomplishments, the pediatric nephrology program at Riley Children’s Health is making a life-changing difference for children and young adults with complex kidney disease. Just eight years ago, the program consisted of three full-time and two part-time nephrologists whose sole focus was high-volume clinical care. Today, the division’s 10 nephrologists are setting a standard for excellence as one of the nation’s leading pediatric nephrology programs with patient outcomes among the nation’s best.

“We’ve been very intentional in building a team with a breadth of experience and interests,” said David Hains, MD, pediatric nephrology division chief at Riley Children’s. “Allowing our physicians to ‘lead in their own lane,’ so to speak, has changed the complexion of our clinical care model in every aspect and with great results.”

Using standardized care guidelines and automated alerts in the EMR, the neonatal AKI surveillance program at Riley Children’s has improved recognition of acute kidney injury in the NICU from 17% to 100%. One of the few initiatives of its kind in the nation, the program follows patients from inpatient care in the NICU through longitudinal follow-up in the Neonatal Kidney Health Program.

In a novel approach to transitional care, Riley Nephrology launched the Pediatric Kidney Transplant Transition Program for adolescents and young adults with kidney transplants. Facilitated by pediatric nephrologist Corina Nailescu, MD, and specialists from adolescent medicine and psychology, the program seeks to reverse the high graft losses common in this age group after transfer to adult care.

“This multidisciplinary program focuses not only on the medicine, but also on the transition to independence and supporting patients in undertaking the responsibilities of their care as an adult kidney patient,” said Dr. Hains. “Fast forward five or 10 years, and I think this program will be widely emulated nationwide.”

The transplant transition program, launched just three years ago, is currently following 42 adolescent and young adult patients. Overall, the post-kidney transplant population at Riley Children’s has increased from 88 in 2019 to 141 in 2024.

On the inpatient front, next-level enhancements in inpatient continuous renal replacement therapy (CRRT) are contributing to improved acute kidney care in the ICU. Telemedicine initiation of CRRT, implemented during the COVID-19 pandemic, has made it easier to get renal replacement up and running quickly.

“With virtual starts we can launch CRRT in an hour or 90 minutes, if we need to, and we’ve seen our volumes go way up,” said Dr. Hains. “We’ve published on the safety of virtual starts, which have really been a game changer for our patients with acute kidney disease.”

Since 2018, CRRT days at Riley Children’s have jumped from about 300 to well over 1,200.

“We’ve been deliberate in assembling a team that’s excellent not only on paper but professionals who really care about our patients and one another and want to do more whether through quality improvement, research or education,” said Dr. Hains. “It’s all about giving our patients a better chance of having a somewhat normal childhood despite chronic kidney disease—it’s the reason we come to work every day.”

Learn more about the nephrology program at Riley Children’s Health.