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Reducing Acute Kidney Injury in Critically Ill Pediatric Patients: Quality Improvement Project Targeting Nephrotoxic

Natalie Capretta1, Diana Zepeda-Orozco2,3,4, W Joshua Frazier1

  • 1Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 30, 2025
PubMed

Insights

A quality improvement initiative reduced acute kidney injury (AKI) in critically ill children exposed to nephrotoxic medications (NTM). Pharmacist-led education and daily alerts significantly lowered NTM exposure and NAKI rates.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Quality Improvement Science

Background:

  • Nephrotoxic medications (NTM) are a significant risk factor for acute kidney injury (AKI) in critically ill pediatric patients.
  • Structured interventions are needed to mitigate NTM-associated AKI (NAKI) in the pediatric intensive care unit (PICU).

Purpose of the Study:

  • To decrease the incidence of AKI resulting from nephrotoxic medication exposure in critically ill children.
  • To implement and evaluate a quality improvement (QI) initiative targeting NTM use in the PICU.

Main Methods:

  • A prospective, multi-phased QI project was conducted at a quaternary care children's hospital.
  • Interventions included pharmacist-led education, informational handouts, and daily clinical pharmacist notifications of NTM exposure.
  • Data on NTM exposure and NAKI rates were collected pre- and post-intervention.

Main Results:

  • NTM exposure rates decreased by 12.4% (30.6 to 26.9 per 1000 patient-days).
  • NTM-associated AKI (NAKI) rates saw a significant reduction of 55% (5.6 to 2.5 per 1000 patient-days).
  • The study included 34,631 patient-days over a 20-month period.

Conclusions:

  • Targeted QI interventions, including education and pharmacy alerts, effectively reduced NTM exposure and NAKI in critically ill pediatric patients.
  • Pharmacy-driven notifications and stakeholder education are key components for NTM stewardship.
  • Ongoing efforts focus on institutional integration and sustainability of these successful strategies.
Abstract

Keywords:
critical illnessintensive care unitsnephrotoxic acute kidney injurypediatricsquality improvement

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