Choosing the Right Kidney Care Program for Your Child: Why Ranking Matters

Children’s Mercy is recognized as one of the top five kidney care programs in the nation, and has been ranked in the top 10 by U.S. News & World Report for the past eight years.

We asked, Dr. Bradley Warady, Division Director of Pediatric Nephrology, and Director of Dialysis and Transplantation, what it means to be ranked and why ranking matters when it comes to your child’s care.

How are U.S. News & World Report rankings determined?

Dr. Warady: U.S. News & World Report sends out surveys for different specialties to hospitals across the U.S. In the case of my specialty, it would be pediatric nephrology. Rankings are determined by key clinical data such as patient outcomes, infection prevention and resources at the institution. In addition, part of the hospital’s score is derived from peer input about which programs pediatric nephrologists believe are the best programs in the nation.

Why should parents care about rankings?

Dr. Warady: Children with end-stage kidney disease and the need for dialysis or a kidney transplant tend to be extremely complex patients, and centers that are ranked high have excellent patient outcomes, which is most important to parents. We have a 100% successful transplant rate and our dialysis program has one of the lowest infection rates in the country.

Of course, this isn’t to say that centers not ranked in the top 10 or top 20 can’t provide good care for children on dialysis, with a transplant or with other kidney disorders, because they can. However, the top-ranked programs are proven centers of excellence and have the resources necessary to achieve the best patient outcomes.

In addition to pediatric nephrologists, top-ranked kidney programs will also have a multidisciplinary team comprised of surgeons, nurses, social workers, dieticians, pharmacologists, transplant coordinators, psychologists, child life specialists and education coordinators. In most cases, they are also actively involved in a variety of research activities.

Ranking isn’t everything, so what advice do you have for parents looking for a kidney program?

Dr. Warady: Number one, parents should look at the expertise the center provides with respect to the disorder for which their child will need treatment. If a child has kidney failure, parents should ask about outcomes regarding infection prevention, as well as dialysis and transplant outcomes. They should find out how many transplants have been performed at the center, and most importantly, how long those transplants are lasting.

If, on the other hand, the child has a different kidney related disorder such as metabolic bone disease, recurrent urinary tract infections, high blood pressure or bedwetting, the parent should seek out information regarding the expertise of the physicians and staff in the program in caring for these disorders. A program that has the capacity to successfully address all of these and other kidney issues will best meet the needs of the patients and their families.

They should also make sure the center has a well-established transition program. Transition education is critical for children as they become a young adult, so they can develop the skills necessary to manage their condition when they move from pediatric to adult kidney care. We have one of the most developed nephrology transition programs in the county and we closely collaborate with our adult counterparts to best determine what these children need to know before moving to adult care. As part of this collaboration, and to complement our transition education curriculum, we recently initiated a transition readiness checklist that is completed by children that we care for every year starting at 12 years of age. This serves as a blueprint for what the child needs to know about their medical management, so they are prepared to transfer to adult care by 22 years of age.

Lastly, parents should find a center that focuses on family-centered care.

Why is family-centered care important?

Dr. Warady: The family-centered approach permeates throughout our division of nephrology. We recognize that a partnership must exist between families and health care providers if we are to provide the best, and most practical approach to care.

Families need to be part of the care team. It simply doesn’t work if a doctor recommends a plan that’s not practical to implement in the home situation. In most cases, parents know what they can do and what the child can do, so we need to work together on what works best for that particular patient and family to get the best outcome.

Our parents play a key role in our success. Every year when the rankings come out, I meet with the patients and families of children on dialysis or with a kidney transplant to say thank you, because the rankings are in large part based on outcomes. The Children’s Mercy kidney program wouldn't be able to achieve the great outcomes that we have achieved if the kids and families weren’t so supportive of our efforts by carrying out the recommendations that we have developed together.

As health care providers, we make recommendations of care, but the management is carried out by the patients and families; and that partnership is what excellent pediatric care is all about.

What does it mean for this program to be continuously ranked year-after-year?

Dr. Warady: I believe that what’s most important about the ranking is the affirmation that our kidney program and our hospital is doing a great job caring for the kids and families that look to us for help. The faculty and staff work extremely hard to achieve the best possible outcomes for these kids. Of course, the rankings also serve as a stimulus to improve and not rest on our laurels. We have set the bar high for ourselves in terms of expectations and we continuously try to exceed what we have achieved in years past.

Any other advice for families looking for a kidney program?

Dr. Warady: Families should know they have the opportunity to speak with us or visit with us before committing to the care we provide. We encourage families to “test us out.” You kick the tires before you purchase a car and you should have the same opportunity with your health care provider, and we welcome that.

Learn more about the Nephrology Program at Children’s Mercy.

Learn more about the Kidney Transplant Program at Children’s Mercy, the largest pediatric transplant program in Missouri and Kansas.

Learn more about the Dialysis Program at Children’s Mercy.

Read Dr. Warady’s blog “The Doctor-Patient Relationship: How it Impacts Your Care.”