Acute kidney injury (AKI) occurs in 16%–25% of patients who are hospitalized and is linked to death and higher risk of chronic kidney disease and permanent kidney failure (1–4). As recovery from moderate to severe AKI may take several months, patients are discharged to recover through self-management and outpatient care. Yet, studies investigating AKI intervention outside of the hospital setting are limited.
Research studies on pharmacotherapy to treat AKI have shown disappointing results, leading to increased interest in improving processes of care for AKI. This is because the health care needs of patients with AKI are variable and dynamic. Depending on the type of AKI, severity of AKI, kidney recovery, and comorbidities, each patient will need a different care plan. Some patients will need full nephrology care at the dialysis unit, whereas some patients will need intermittent monitoring of kidney function, medication dosing adjustment, and resumption of nephroprotective medication. However, there is no clear evidence for how to care for patients who survive an episode of AKI after hospitalization. Barriers to developing interventions for post-AKI care are numerous and include: 1) a lack of understanding about the different phenotypes of AKI and their recovery period; 2) heterogeneity in the definition of kidney recovery; 3) suboptimal transition of care plans due to poor communication channels; and 4) high variability in care delivered after hospital discharge in terms of specialties (nephrology vs primary care), modalities (in-person vs televisits), and frequency of follow-up (5, 6).
Interventions to improve post-AKI care
Research communities and professional AKI workgroups recognize the need to improve post-AKI care. The Acute Disease Quality Initiative and the AKINow: Recovery/Post-AKI Workgroup have included post-AKI care as part of their research priorities (5, 6). Additionally, the National Institute of Diabetes and Digestive and Kidney Diseases recently awarded grant funding to the University of Pittsburgh, Cleveland Clinic, and Vanderbilt University Medical Center for the Caring for Outpatients after AKI study. The goal of the 5-year project is to assess interventions to improve clinical and patient-centered outcomes after a patient has developed an AKI.
Thus, for 2023, we anticipate more publications related to the following:
Identification of best practices and interventions to improve clinical and patient-centered outcomes
More effort into understanding and improving processes for post-AKI care
Review standardized definition of AKI recovery and outcome measures
The use of digital technology to improve post-AKI care (e.g., telemedicine, digital mobile platforms, and better health information technology interoperability)
Effective education for health providers, patients, and care partners.
References
- 1.↑
Coca SG, et al. Chronic kidney disease after acute kidney injury: A systematic review and meta-analysis. Kidney Int 2012; 81:442–448. doi: 10.1038/ki.2011.379
- 2.
Heung M, et al. Acute kidney injury recovery pattern and subsequent risk of CKD: An analysis of Veterans Health Administration data. Am J Kidney Dis 2016; 67:742–752. doi: 10.1053/j.ajkd.2015.10.019
- 3.
Hoste EA, et al. Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study. Intensive Care Med 2015; 41:1411–1423. doi: 10.1007/s00134-015-3934-7
- 4.↑
Zeng X, et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014; 9:12–20. doi: 10.2215/CJN.02730313
- 5.↑
Chawla LS, et al. Acute kidney disease and renal recovery: Consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 2017; 13:241–257. doi: 10.1038/nrneph.2017.2
- 6.↑
American Society of Nephrology. AKINOW: Recovery/Post-AKI Workgroup. Accessed December 5, 2022. https://epc.asn-online.org/projects/akinow/akinow-recovery-post-aki-workgroup/
