The ASN AKINow Initiative: Defining Excellence in the Prevention and Care of Patients with Acute Kidney Injury

AKINow was created in the spring of 2019 to address the rising incidence of acute kidney injury (AKI), which is estimated to affect more than 13 million hospitalized people every year around the world (1). AKI survivors have a higher risk of death, rehospitalization, recurrent AKI, chronic kidney disease (CKD), and lower quality of life than patients discharged from the hospital without an AKI diagnosis (2). The mission of AKINow is “to promote excellence in the prevention and treatment of [AKI] by building a foundational program that transforms the delivery of AKI care, reduces morbidity and mortality, and improves long-term outcomes.”

Over the past year, AKINow's workgroups have approached this mission through the development of novel educational content and platforms, outreach to the kidney community and engagement with patient advocates, and dissemination of best practice information to both clinicians and individuals affected by AKI.

• The Public Awareness and Education Workgroup has completed a scoping literature review, which revealed a dearth of information regarding education for patients who have experienced AKI. Subsequently, the workgroup hosted a focus group session with diverse AKI stakeholders, including patients in May 2023, to identify barriers to AKI education for both patients and practitioners. Areas for improvement that emerged from these discussions included communication among practitioners, better information for patients about the kidneys, clarity on whether a patient is being discharged with an AKI versus an end stage kidney disease diagnosis, and improved information at discharge to facilitate the transition to outpatient care for individuals who are affected. In 2024, along with developing new educational material to address these unmet needs, this workgroup will pursue relationships with non-nephrology societies to increase awareness of AKI.

• The Basic Science: AKI-Specific Early Interventions Workgroup is pursuing methods to promote collaborative and inclusive discovery research that translates more effectively to patients. In 2023, the workgroup launched a virtually hosted AKINow Journal Club to foster discussion in the community on emerging, high-impact research. The first Journal Club presented a manuscript, published in The Journal of Clinical Investigation (3), on new mechanisms of AKI-to-CKD transitions, and the second discussed a randomized clinical trial of electronic health record alerts to improve AKI prevention and outcomes, published in Nature Communications (4). Recordings of the first two Journal Club events are available on the AKINow website (https://epc.asn-online.org/projects/akinow/). The workgroup is also developing a proposal for a new curriculum to lower entry barriers for researchers interested in the application of data science to AKI. This unique program would include the basics of conducting research studies, introduce learners to freely available statistical software, and assist participants in performing their own statistical coding. The program will focus on recruiting students from minority groups and community hospitals who are less likely to have access to the tools needed to conduct research.

• The AKI Recovery Workgroup aims to identify challenges and opportunities to improve post-AKI care (5, 6). Survivors of AKI are a high-risk, growing population with poor long-term outcomes. How to care for patients after AKI remains ill-defined and with substantial practice variation. In fall 2021 and spring 2022, the workgroup hosted two focus group sessions to determine gaps in care and to understand the challenges and opportunities in developing evidence-based practice recommendations for the care of survivors of AKI. The workgroup is currently designing a Delphi process to gather insight on survivorship care plans that organize information about recommended follow-up care. This includes how often examinations are needed, required testing, and potential late effects of AKI that should be monitored. The Delphi technique is a method of group decision-making and forecasting that involves successively collating the judgments of experts. Through this process, the group will focus on the population with non-dialysis AKI (patients or family members of patients who have experienced AKI but did not require dialysis) and with practitioner-to-practitioner and practitioner-to-patient communications. The outcome of this process will be two model survivorship care plans (one for patients and a second for practitioners) to guide post-AKI care.

• The Artificial Intelligence (AI) Workgroup aims to help clinicians, patients, and researchers use AI to improve the quality, accessibility, affordability, and equity of care. Efforts to mobilize data to improve health care delivery and patient outcomes are rapidly reaching every corner of medicine. ASN's focus on data science and AI commenced in this AKINow workgroup to develop ways to use electronic health data to predict, prevent, and mitigate the impact of AKI in hospitalized patients. This workgroup has evolved, via the ASN's Task Force on Augmented Intelligence and Digital Health recommendation, which focuses on coordinating activities across many of ASN's interest areas beyond AKI to accelerate the integration of digital health into the care of patients with kidney diseases. Prior to establishing ASN's Task Force on Augmented Intelligence and Digital Health, the AKINow AI Workgroup organized several webinars with leaders in the field (from nephrology and beyond) on the basic concepts of augmented intelligence and clinical decision support. These educational offerings can be found on the AKINow website. The workgroup anticipates continuing its support of the larger nephrology community in this area of AI and AKI.

AKI is common, serious, under-recognized, and strongly associated with increased risk of adverse outcomes. Early recognition is essential. Therapies to prevent or treat AKI are sorely needed. Post-AKI recovery care is essential to improve long-term outcomes that significantly impact individuals and society. Such efforts will require close interaction and cross-pollination among patients, scientists, clinicians, academics, and regulatory and industry partners to achieve better AKI outcomes.