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Children’s Mercy Physician Leads Development of Patient-focused Report to Improve Clinical Care for Pediatric CKD

Bradley Warady, MD, Division Director of Pediatric Nephrology at Children’s Mercy Kansas City and Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, is the lead author on an innovative new publication, “Improving Clinical Care for Children with CKD: A Report from a National Kidney Foundation Scientific Workshop,” published Nov. 18, 2022, in the American Journal of Kidney Diseases.

The workshop, held in December 2018, included 32 national and international experts in pediatric nephrology and allied fields, and 10 pediatric chronic kidney disease (CKD) patients and their caregivers. The goal of the workshop was to develop key clinical recommendations (KCRs) for pediatric CKD care management based on the perspectives of healthcare providers, patients and parents. The event included plenary talks; patient and family testimonies; break out groups; audience discourse; email discussions; and semi-quantitative scoring of the KCRs based on ease, time and importance of implementation.

"Input from patients and parents/caregivers living with childhood CKD...is an important contribution that we believe has been absent from pediatric CKD related recommendations to date, but that should be incorporated into the development of all future clinical recommendations and more formal guidelines,” Dr. Warady and the reports’ coauthors state.

The report offers prioritized KCRs in five areas:

  • Addressing the Needs of Patients and Parents/Caregivers
    • Top KCRs: Provide access to dietitians and social workers; and encourage patient participation in physical activities and sports.
  • Modifying the Progression of CKD
    • Top KCRs: Screen for and treat modifiable risk factors such as elevated blood pressure and proteinuria; avoid or minimize use of nephrotoxic medications; and treat urinary tract infections in patients with kidney/urinary tract abnormalities.
  • Clinical Management of CKD-Mineral Bone Disorder and Growth Retardation
    • Top KCRs: Recommend age-based calcium intake; consider active Vitamin D analogs to treat increased/rising parathyroid hormone levels; and correct metabolic acidosis.
  • · Clinical Management of Anemia, Cardiovascular Disease and Hypertension
    • Top KCRs: Screen blood pressure at every visit and target < 90th percentile; treat elevated blood pressure pharmacologically as needed, preferably with ACEI/ARB, if tolerated; and screen for dyslipidemia every year.
  • Transition and Transfer of Pediatric Patients to Adult Nephrology Care
    • Top KCRs: Write a transfer letter and share with emerging adult patient; enlist parent guidance and support during the transition and transfer process; and discuss/define expectations during the first visit between emerging adult patient and adult provider.

"All of the KCRs generated from this workshop reflect an integrated approach, spanning several domains and addressing physiological parameters and behavioral patterns for families, health providers, and clinical practices,” Dr. Warady and his co-authors wrote of the report’s commitment to shared decision-making.

The authors hope the report will be used in three distinct ways:

  • That clinicians will integrate the recommendations into their practices
  • That the report will encourage other physician-patient-family collaborations
  • That the challenges of implementing more complex KCRs will highlight the importance of education, advocacy and cooperative action to address the needs of the pediatric CKD population

“The products of this workshop and others designed like it in the future are sure to result in achievement of the mutual goal of all attendees; improved patient care,” said Dr. Warady.


About Us

Children’s Mercy Kansas City is an independent, non-profit, 390-bed pediatric health system, providing over half a million patient encounters each year for children from across the country. Children’s Mercy is ranked by U.S. News & World Report in all ten specialties. We have received Magnet® recognition five times for excellence in nursing services. In affiliation with the University of Missouri-Kansas City, our faculty of nearly 800 pediatric specialists and researchers is actively involved in clinical care, pediatric research and educating the next generation of pediatricians and pediatric subspecialists. The Children’s Mercy Research Institute (CMRI) integrates research and clinical care with nationally recognized expertise in genomic medicine, precision therapeutics, population health, health care innovation and emerging infections. In 2021 the CMRI moved into a nine-story, 375,000-square-foot space emphasizing a translational approach to research in which clinicians and researchers work together to accelerate the pace of discovery that enhances care.