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The First Gap in Life-Course CKD Care: Kidney Follow-up after Neonatal Intensive Care Unit Discharge
Kimiko Honda1, Tokuo Miyazawa2, Reiko Kushima3
1Graduate School of Health Management, Keio University, Tokyo, Japan.
Kidney360
|August 13, 2026
Summary
Kidney care for infants born preterm or with low birth weight is not well-established in Japan. A coordinated care pathway is needed from neonatal intensive care unit (NICU) discharge to ensure proper follow-up for these high-risk infants.
Area of Science:
- Pediatrics
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD) risk can originate at birth, particularly in preterm or low birth weight infants.
- The transition from neonatal intensive care unit (NICU) to home presents a critical gap in longitudinal CKD care for these vulnerable infants.
- Effective CKD care requires integrated pathways for risk recognition, evaluation, follow-up, and specialist input.
Purpose of the Study:
- To describe post-discharge kidney follow-up practices for infants born preterm or with low birth weight in Japan.
- To identify gaps between routine care, current evidence, and recent guidance for infant CKD follow-up.
- To compare the perspectives of neonatologists and pediatric nephrologists on CKD risk identification and follow-up.
Main Methods:
- A nationwide cross-sectional survey was conducted among neonatologists and pediatric nephrologists in Japan.
- The survey utilized mailed invitations with options for web or paper responses.
- Data collected included criteria for identifying high CKD risk, current/preferred follow-up approaches, and perceived barriers, with descriptive analyses comparing specialties.
Main Results:
- Response rates were 52% for neonatologists (n=213) and 69% for pediatric nephrologists (n=137).
- Specialties differed in CKD risk identification criteria, with neonatologists often using <28 weeks gestational age and pediatric nephrologists using 28 to <34 weeks.
- Only 23% of neonatologists reported institutional protocols for post-discharge follow-up, and implementation of kidney follow-up for all high-risk infants was limited (7%), despite 98% of pediatric nephrologists deeming it necessary.
Conclusions:
- Long-term kidney follow-up for high-risk infants is insufficiently established in Japan.
- A significant gap exists in established care pathways from NICU discharge.
- A collaborative care model between neonatology and pediatric nephrology is essential for improving outcomes.
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