• 1.

    Hoste EAJ, et al. Global epidemiology and outcomes of acute kidney injury. Nat Rev Nephrol 2018; 14:607625. doi: 10.1038/s41581-018-0052-0

  • 2.

    Liu KD, et al. AKI!Now initiative: Recommendations for awareness, recognition, and management of AKI. Clin J Am Soc Nephrol 2020; 15:18381847. doi: 10.2215/CJN.15611219

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Kashani K, et al. Quality improvement goals for acute kidney injury. Clin J Am Soc Nephrol 2019; 14:941953. doi: 10.2215/CJN.01250119

  • 4.

    Goldstein SL, et al. A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children. Kidney Int 2020; 97:580588. doi: 10.1016/j.kint.2019.10.015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Vijayan A, et al., for the AKI!NOW Steering Committee. Recovery after critical illness and acute kidney injury. Clin J Am Soc Nephrol [published online ahead of print August 30, 2021]. doi: 10.2215/CJN.19601220; https://cjasn.asnjournals.org/content/early/2021/08/24/CJN.19601220.

    • Search Google Scholar
    • Export Citation
  • 6.

    Silver S, et al. Nephrologist follow-up versus usual care after an acute kidney injury hospitalization (FUSION): A randomized controlled trial. Clin J Am Soc Nephrol 2021; 16:10051014. doi: 10.2215/CJS.17331120

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Singh G, et al. Post-discharge mortality and rehospitalization among participants in a comprehensive acute kidney injury rehabilitation program. Kidney360 July 13, 2021 [early access]. doi: 10.34067/KID/0003672021; https://kidney360.asnjournals.org/content/early/2021/07/13/KID.0003672021

    • Crossref
    • Search Google Scholar
    • Export Citation

The ASN AKI!Now Initiative Defining Excellence in the Prevention and Care of Patients with Acute Kidney Injury

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In hospitals and in the community, the incidence of acute kidney injury (AKI) is high and rising worldwide. At the societal level, AKI is increasingly recognized as a major public health burden (1). For the individual patient, severe AKI is a life-altering event with profound immediate and future consequences. Recently, the COVID-19 pandemic has highlighted the impact of AKI in hospitalized patients with SARS-CoV-2 infection.

AKI is not a single disease, but a syndrome caused by multiple mechanisms in patients with different comorbidities and several potential treatment targets. By developing the AKI!Now initiative, ASN is committed to defining excellence in AKI prevention and care, aiming to describe pathogenic mechanisms, transform management, reduce morbidity and mortality, and improve short- and long-term outcomes (2).

To achieve these goals, AKI!Now has established four workgroups that will design a broad educational program bridging the continuum from basic investigations to clinical studies, focusing on early recognition, intervention, and effective therapies with a patient-centered focus (Figure 1).

The Public Awareness and Education Workgroup leverages existing educational platforms and develops novel educational tools for health professionals and patients. This workgroup launched the interactive AKI!Now Compendium, a searchable database of AKI-related resources within the ASN library of offerings. Further goals of the workgroup include the promotion of AKI quality initiatives, emphasizing the role of continuous quality improvement to enhance AKI recognition and care (3). These initiatives extend not only to the nephrology community but importantly, they aim to expand into all domains of clinical practice by interacting and developing new knowledge together with all medical and surgical specialists, recognizing that AKI recognition and management often rest on non-nephrology practitioners. Woven through all educational efforts is the acknowledgment that patients and their families are an intrinsic part of the recognition and healing process.

The focus of the Basic Science: AKI-Specific Early Interventions Workgroup is broad, spanning from molecular and cell biology research to investigator education. The group will pursue goals to promote collaborative and inclusive discovery research that translates more effectively to patients, including:

  • Developing a centralized, searchable database portal that provides a resource for the research community

  • Lowering entry barriers for researchers interested in AKI by developing interactive educational content

  • Promoting greater collaboration among AKI basic researchers, translational investigators, and researchers in other fields

  • Articulating a preclinical roadmap that facilitates the translation of new discoveries to novel therapies

  • Enhancing communication around AKI innovation by fostering an open and vibrant community of patients, researchers, clinicians, and other stakeholders to promote a culture of continuous innovation

The AKI Recognition and Clinical Interventions: Artificial Intelligence (AI) Workgroup has outlined objectives in three key domains:

  1. Patients. Generate input in designing and implementing fair and equitable AI tools, and identify clinical scenarios based on personal and caregiver experience that could be improved with AI.

  2. Clinicians. Incorporate clinician input in the design, value, and implementation of fair and equitable AI tools, and identify clinical uncertainties that may benefit from new AI tools.

  3. Researchers. Evaluate current AI processes with a focus on removing implicit bias; develop novel, feasible, and effective AI tools to address gaps identified by patients and clinicians; and develop and implement AI methods with novel sensors for more sensitive assessment of kidney function and injury to advance the science of AKI diagnosis and treatment.

This project, with involvement from a multi-disciplinary group of collaborators, aims to promote efficient and effective use of AI for quality improvement in AKI care, such as the NINJA (Nephrotoxic Injury Negated by Just-in-time Action) (4).

Specific deliverables include developing risk-stratification and prediction tools; intelligent alert tools; decision support for bundled care compliance; and decision support for implementing pragmatic clinical trials. Importantly, this work will fill gaps to validate available AI tools and to develop new AI tools that do not currently exist, to deliver highly useful AI implements to improve AKI care and research and reduce costs.

The AKI Recovery Workgroup aims to identify challenges and opportunities to improve post-AKI care (57); research options to include a wide spectrum of interventions spanning from the role of the angiotensin-converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), and sodium-glucose cotransporter 2 inhibitors (SGLT2i), to the importance of physical, mental, and cognitive rehabilitation; and to develop tests and supportive strategies that build capacity for delivery of post-AKI care.

Survivors of AKI are a high-risk, growing population, with potentially poor long-term outcomes. How to care for patients after AKI remains ill-defined and with substantial practice variation. In fall 2021, the workgroup will host two focus group sessions to outline challenges and opportunities in developing evidence-based practice in post-AKI on dialysis (AKI-D) care and to determine gaps in care of AKI survivors.

In conclusion

AKI is common, serious, underrecognized, and strongly associated with increased risk of progressive adverse outcomes. Early recognition is essential, and AI improves pattern recognition and awareness, prevention, and management. Developing AKI-specific therapies is indispensable; a better understanding of AKI basic science will lead to the development of effective treatments. Post-AKI recovery care is necessary to alleviate long-term sequelae that severely impact individuals and society. Such efforts will require close interaction and cross-pollination as the most effective pathway to achieve better AKI outcomes, in close collaboration with patients and their families

During Kidney Week, join AKI!Now for a Town Hall conversation highlighting the barriers and facilitators to quality care for patients with AKI.

Workgroup members

AKI!Now Chair: Jorge Cerdá, MD, MS, FASN

  • Public Awareness and Education Workgroup: Jorge Cerdá, MD, MS, FASN (Chair); Guarav Jain, MD, FASN; Marla Levy; Andrew Lewington, MD; Kathleen Liu, MD, FASN; Etienne Macedo, MD, PhD, FASN; Marlies Ostermann, MD, PhD

  • Basic Science Workgroup: Samir M. Parikh, MD, FASN (Chair); Anupam Agarwal, MD, FASN; Amandeep Bajwa, PhD; Jorge Cerdá, MD, MS, FASN; Leslie Gewin, MD; Sanjeev Kumar, MD, MBBS, PhD; Sherry Man-sour, MD, MS; Mark D. Okusa, MD, FASN

  • Artificial Intelligence Workgroup: Jay L. Koyner, MD (Chair); Azra Bihorac, MD, MS, FASN; Jorge Cerdá, MD, MS, FASN; Stuart Goldstein, MD, FASN; Kianoush Kashani, MD; Shina Menon, MD; Girish N. Nadkami, MD, MPH; Javier A. Neyra, MD, MS, FASN; Neesh I. Pannu, MD, MS; Karandeep Singh, MD, MS; Danielle Soranno, MD

  • Recovery Workgroup: Erin Barreto, PharmD, MS, FASN (Co-Chair); Anitha Vijayan, MD, FASN (Co-Chair); Emaad Abdel-Rahman, MD, PhD, FASN; Leslie Gewin, MD; Javier A. Neyra, MD, MS, FASN; Samuel Silver, MD, MS, FASN

References

  • 1.

    Hoste EAJ, et al. Global epidemiology and outcomes of acute kidney injury. Nat Rev Nephrol 2018; 14:607625. doi: 10.1038/s41581-018-0052-0

  • 2.

    Liu KD, et al. AKI!Now initiative: Recommendations for awareness, recognition, and management of AKI. Clin J Am Soc Nephrol 2020; 15:18381847. doi: 10.2215/CJN.15611219

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Kashani K, et al. Quality improvement goals for acute kidney injury. Clin J Am Soc Nephrol 2019; 14:941953. doi: 10.2215/CJN.01250119

  • 4.

    Goldstein SL, et al. A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children. Kidney Int 2020; 97:580588. doi: 10.1016/j.kint.2019.10.015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Vijayan A, et al., for the AKI!NOW Steering Committee. Recovery after critical illness and acute kidney injury. Clin J Am Soc Nephrol [published online ahead of print August 30, 2021]. doi: 10.2215/CJN.19601220; https://cjasn.asnjournals.org/content/early/2021/08/24/CJN.19601220.

    • Search Google Scholar
    • Export Citation
  • 6.

    Silver S, et al. Nephrologist follow-up versus usual care after an acute kidney injury hospitalization (FUSION): A randomized controlled trial. Clin J Am Soc Nephrol 2021; 16:10051014. doi: 10.2215/CJS.17331120

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Singh G, et al. Post-discharge mortality and rehospitalization among participants in a comprehensive acute kidney injury rehabilitation program. Kidney360 July 13, 2021 [early access]. doi: 10.34067/KID/0003672021; https://kidney360.asnjournals.org/content/early/2021/07/13/KID.0003672021

    • Crossref
    • Search Google Scholar
    • Export Citation
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