{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:56:07Z","timestamp":1777859767430,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,3,26]],"date-time":"2022-03-26T00:00:00Z","timestamp":1648252800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>\n                    Background: Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hospitalized children and is associated with chronic kidney disease (CKD). The pharmacist-reliant NINJA program reduced nephrotoxic medication exposure and associated AKI. Objectives: We assess potential healthcare cost savings from reduced CKD by preventing AKI with the NINJA program for a pediatric population through age 21. Methods: We simulated a cohort of 1000 hospitalized non-critically ill children. From the published literature, 310 develop AKI, 267 survive to 6 months, and 10-70% develop CKD, and NINJA implementation reduced AKI by 23.8%. Allowing for varying CKD rates, we estimated a range of NINJA\u2019s savings. We assumed an annual GFR decline of 1.2 (noHTN) ml\/min\/1.73\u00a0m\n                    <jats:sup>2<\/jats:sup>\n                    for half the sample and 1.7 (HTN) ml\/min\/1.73\u00a0m\n                    <jats:sup>2<\/jats:sup>\n                    for the other half to account for CKD progression without and with hypertension (HTN). We model attributable costs including CKD stage-related medications and outpatient visits\/tests in 2018 dollars discounted at 3%. We subtract the cost of NINJA screening (daily serum creatinine and pharmacist time) from net savings. We exclude end-stage renal disease (ESRD) and hospitalization costs. Results: No intervention estimated CKD related costs are $761,852 to $5,735,027. Post-NINJA cost decreases to $616,086 to $4,312,183 (net savings: $145,766 to $1,422\u00a0183). Total savings, accounting for NINJA screening ($256,680) are -$110,914 to $1,1\u00a0165\u00a0503. The breakeven AKI to CKD conversion rate is 13-14% with growth hormone cost included, and 64-65% without. Conclusion: The NINJA program is likely cost beneficial, with greater savings into adulthood by avoiding\/delaying ESRD and its costs.\n                  <\/jats:p>","DOI":"10.1177\/08971900221074978","type":"journal-article","created":{"date-parts":[[2022,3,26]],"date-time":"2022-03-26T22:53:41Z","timestamp":1648335221000},"page":"795-802","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Healthcare Cost Savings of a Pediatric Nephrotoxic Medication-Associated Acute Kidney Injury Reduction Program in a Simulated Sample"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1218-2871","authenticated-orcid":false,"given":"Linda","family":"Dynan","sequence":"first","affiliation":[{"name":"Department of Economics and Finance, Northern Kentucky University, Highland Heights, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Lazear","sequence":"additional","affiliation":[{"name":"Division of Pharmacy, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart L.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,3,26]]},"reference":[{"key":"bibr1-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2004.09.028"},{"key":"bibr2-08971900221074978","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08110910"},{"key":"bibr3-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq375"},{"key":"bibr4-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2012.11.069"},{"key":"bibr5-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-0794"},{"key":"bibr6-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.03.031"},{"key":"bibr7-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.10.015"},{"key":"bibr8-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5000032"},{"key":"bibr9-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.10.048"},{"key":"bibr10-08971900221074978","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.12101112"},{"key":"bibr11-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.10.1360"},{"key":"bibr12-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2014.04.058"},{"key":"bibr13-08971900221074978","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/kisup.2012.73","volume":"3","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2013","journal-title":"Kidney Int"},{"key":"bibr14-08971900221074978","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07480714"},{"key":"bibr15-08971900221074978","unstructured":"Pharmacy pricing. Medicaid. Federal Upper Limit-[cited 2018 March 16]. Available from https:\/\/www.medicaid.gov\/medicaid\/prescription-drugs\/pharmacy-pricing\/index.html."},{"key":"bibr16-08971900221074978","unstructured":"Pharmacy pricing. Medicaid. National Average Drug Acquisition Cost (NADAC) data-[cited 2018 February 14]. Available from https:\/\/www.medicaid.gov\/medicaid\/prescription-drugs\/pharmacy-pricing\/index.html."},{"key":"bibr17-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-006-0410-1"},{"key":"bibr18-08971900221074978","unstructured":"Honeycutt AA, Clayton L, Khavjou O, et al. Guide to Analyzing the Cost-Effectiveness of Community Health Prevention Approaches March 2006. Available from https:\/\/aspe.hhs.gov\/system\/files\/pdf\/74686\/report.pdf."},{"key":"bibr19-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-017-0599-1"},{"key":"bibr20-08971900221074978","unstructured":"CareOperative LLC. Healthcare Bluebook c2017 [cited March 2018]. Available from https:\/\/www.healthcarebluebook.com\/ui\/home"},{"key":"bibr21-08971900221074978","unstructured":"Payscale Inc (2018). [cited 2018 March]. Available from https:\/\/www.payscale.com\/research\/US\/Job=Pharmacist\/Salary."},{"key":"bibr22-08971900221074978","volume-title":"Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health","author":"United States Renal Data System","year":"2019"},{"key":"bibr23-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2012040392"},{"key":"bibr24-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000125670.64996.BB"},{"key":"bibr25-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-012-2165-1"},{"key":"bibr26-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2019.08.046"},{"key":"bibr27-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2019.04.022"},{"key":"bibr28-08971900221074978","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28396"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900221074978","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08971900221074978","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900221074978","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:37:18Z","timestamp":1777509438000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08971900221074978"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,26]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1177\/08971900221074978"],"URL":"https:\/\/doi.org\/10.1177\/08971900221074978","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,26]]}}}