Pediatric Nephrology Practice in the US: Survey of Pediatric Nephrology Division Directors

Document Type

Journal Article

Publication Date

4-4-2025

Journal

American journal of kidney diseases : the official journal of the National Kidney Foundation

DOI

10.1053/j.ajkd.2025.01.025

Abstract

RATIONALE & OBJECTIVES: Addressing the growing demand for pediatric nephrology care is challenging because of increasing limitations in the size of this workforce. The objective of this study was to characterize the state of pediatric nephrology practices across the US to inform possible strategies to address this shortfall. STUDY DESIGN: Cross-sectional survey. SETTING & PARTICIPANTS: The American Society of Pediatric Nephrology (ASPN) interest group comprised of 92 pediatric nephrology division leaders of pediatric nephrology programs. EXPOSURES: Practice size defined by number of full-time equivalent (FTE) pediatric nephrologists. OUTCOMES: The scope of inpatient and outpatient services related to dialysis and extracorporeal treatment, kidney transplantation, procedures (kidney biopsy, ultrasound, ambulatory blood pressure monitoring), faculty roles, and funding for programmatic activities. ANALYTICAL APPROACH: Descriptive and comparative statistics, including Chi-Squared test, Fisher's Exact test, Student's t-Test, two proportion Z-test, with significance defined as p-value < 0.05 was performed using GraphPad Prism (version 8.0.0, 131) and SAS Enterprise guide 7.1. RESULTS: Large programs had more outreach capacity, ancillary staffing, independent transplant programs, diverse kidney replacement options, and on-site outpatient dialysis units. Smaller programs had fewer ambulatory patients and fewer inpatients per FTE pediatric nephrologists. Medium-sized programs had the highest inpatient and ambulatory volume per FTE pediatric nephrologists. The administrative support for transplant/dialysis/fellowship programs was often limited. LIMITATIONS: Granularity of data was limited. Assessment of trends was not implemented nor were changes in faculty appointment type. CONCLUSIONS: Pediatric nephrologists in medium-sized programs had the highest volume of clinical work and administrative support for transplant/dialysis/fellowship programs was often insufficient in many programs. These findings may inform strategies to support pediatric nephrology programs and enhance the care they provide.

Department

Pediatrics

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