• Samuel A Silver, Mitra K Nadim, Donal J O'Donoghue, Francis P Wilson, John A Kellum, Ravindra L Mehta, Claudio Ronco, Kianoush Kashani, Mitchell H Rosner, Michael Haase, and LewingtonAndrew J PAJPRenal Department, St. James's University Hospital, Leeds, UK; NIHR Diagnostic Evidence Co-operative, Leeds, UK..
• Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ont, Canada. Electronic address: samuel.silver@queensu.ca.
• Am. J. Med. 2020 May 1; 133 (5): 552-560.e3.

AbstractAs the incidence of acute kidney injury (AKI) increases, prevention strategies are needed across the health care continuum, which begins in the community. Recognizing this knowledge gap, the 22nd Acute Disease Quality Initiative (ADQI) was tasked to discuss the evidence for quality-of-care measurement and care processes to prevent AKI and its consequences in the community. Using a modified Delphi process, an international and interdisciplinary group provided a framework to identify and monitor patients with AKI in the community. The recommendations propose that risk stratification involve both susceptibilities (eg, chronic kidney disease) and exposures (eg, coronary angiography), with the latter triggering a Kidney Health Assessment. This assessment should include blood pressure, serum creatinine, and urine dipstick, followed by a Kidney Health Response to prevent AKI that encompasses cessation of unnecessary medications, minimization of nephrotoxins, patient education, and ongoing monitoring until the exposure resolves. These recommendations give community health care providers and health systems a starting point for quality improvement initiatives to prevent AKI and its consequences in the community.Copyright © 2019 Elsevier Inc. All rights reserved.

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