Johns Hopkins protocol improved cyst screening for children on chronic dialysis
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A protocol focused on education and specific guidelines led to improvements in screening for acquired cystic kidney disease in children receiving treatments at a Johns Hopkins pediatric dialysis unit.
“Acquired cystic kidney disease (ACKD) is a known complication of end-stage kidney disease (ESKD) and under-recognized in the pediatric population,” Katherine Jones, MD, and Hannah Kim, MD, both of Johns Hopkins University, wrote in a poster presented at the Annual Dialysis Conference. “These acquired cysts have malignant potential but are usually asymptomatic, making regular screening necessary.”
According to Jones and Kim, barriers to screening include coordination with the radiology team to schedule the screening and a “lack of physician awareness.”
To increase the number of patients who received adequate screening, several methods were implemented. The first focus was placed on bolstering dialysis provider awareness and education; this was achieved through the mandatory review of journal articles related to ACKD. Patients were also given educational handouts.
The screening protocol itself consisted of identifying all patients who had been on dialysis at least 1 year (repeated each January); a note was added to the dialysis provider to perform screening for these patients (patients were given ultrasound appointment reminder slips).
Of the 16 patients who met the criteria for cyst screening, 13 had imaging. Of these, two patients had cysts (both were Bosniak class 1).
For patients who did not have cysts, they were scheduled to have another ultrasound the following year.
“In our unit, incorporating screening into [the] dialysis template note and increased provider education resulted in over 70% of patients receiving adequate screening,” Jones and Kim wrote. “Given risk for malignancy with ACKD, those who experience longer times on dialysis, should be screened.”
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Jones K and Kim H. Improving screening for acquired cystic kidney disease in a pediatric dialysis unit.
Presented at: The Annual Dialysis Conference. March 5-7, 2021 (virtual meeting).
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