‘NINJA’ Program Decreases Acute Kidney Injury in Multi-Hospital Study
Published November 2019 | Kidney International
For children admitted to the hospital, nephrotoxic medications (NTMx) can commonly lead to acute kidney injury (AKI). More than 80% of non-critically ill hospitalized children receive a NTMx; between 10% and 49% of children who survive AKI develop chronic kidney disease.
In hospitals without systematic kidney function surveillance, AKI due to medications often goes unnoticed. In fact, various studies show that serum creatinine levels—commonly assessed to detect kidney function decline—are measured at least every four days for only 50-60% of children receiving multiple NTMx.
In 2011, Cincinnati Children’s physicians implemented the Nephrotoxic Injury Negated by Just-in-time Action (NINJA) program to screen all non-critically ill hospitalized patients for high NTMx exposure and obtain daily serum creatinine levels in those patients. The NINJA program decreased NTMx-associated acute kidney injury by 64%.
The NINJA program, funded by the Agency for Health Research and Quality, was implemented at nine other pediatric institutions between 2015 and 2017, which accounted for a combined 638,695 inpatient hospital days. AKI prevalence declined, on average, by eight cases per 1,000 patient days.
“The study shows that the improvements we found at Cincinnati Children’s can be realized by other institutions, even though they may be of different size and makeup and have different resources than here,” says lead author Stuart Goldstein, MD, director, Center for Acute Care Nephrology.
Using NINJA, the hospitals demonstrated a significant and sustained 23.8% decrease in NTMx-AKI rates. Moreover, researchers noted that NINJA’s trigger to alert the healthcare team to increasing NTMx burden likely also helped focus their attention on deciding which medications were necessary and which could be discontinued or substituted with less nephrotoxic alternatives. Researchers are working with more centers in a mentorship program called CUSTOM NINJA to accelerate its adoption.
