Quality of Care for Acute Kidney Disease: Current Knowledge Gaps and Future Directions

Kathleen D Liu; Lui G Forni; Michael Heung; Vin-Cent Wu; John A Kellum; Ravindra L Mehta; Claudio Ronco; Kianoush Kashani; Mitchell H Rosner; Michael Haase; Jay L Koyner; Acute Disease Quality Initiative Investigators

doi:10.1016/j.ekir.2020.07.031

Quality of Care for Acute Kidney Disease: Current Knowledge Gaps and Future Directions

Kidney Int Rep. 2020 Aug 6;5(10):1634-1642. doi: 10.1016/j.ekir.2020.07.031. eCollection 2020 Oct.

Authors

Collaborators

Acute Disease Quality Initiative Investigators:
Jay L Koyner, Kathleen D Liu, Lui G Forni, Kianoush Kashani, Michael Heung, Vin-Cent Wu, John A Kellum, Michael Haase, Claudio Ronco, Ravi Mehta

Affiliations

¹ Division of Nephrology, Departments of Medicine and Anesthesia, University of California, San Francisco, California, USA.
² Division of Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, California, USA.
³ Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK.
⁴ Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁶ Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁷ Division of Nephrology, Department of Medicine, University of California, San Diego Medical Center, San Diego, San Diego, California, USA.
⁸ Department of Medicine (DIMED), University of Padova, Padova, Italy.
⁹ Department of Nephrology, Dialysis and Transplantation, and International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
¹⁰ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹² Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA.
¹³ Medical Faculty, Otto-von-Guericke University Magdeburg and Diaverum MVZ, Potsdam, Germany.
¹⁴ Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.

Abstract

Acute kidney injury (AKI) and acute kidney disease (AKD) are common complications in hospitalized patients and are associated with adverse outcomes. Although consensus guidelines have improved the care of patients with AKI and AKD, guidance regarding quality metrics in the care of patients after an episode of AKI or AKD is limited. For example, few patients receive follow-up laboratory testing of kidney function or post-AKI or AKD care through nephrology or other providers. Recently, the Acute Disease Quality Initiative developed a consensus statement regarding quality improvement goals for patients with AKI or AKD specifically highlighting efforts regarding quality and safety of care after hospital discharge after an episode of AKI or AKD. The goal is to use these measures to identify opportunities for improvement that will positively affect outcomes. We recommend that health care systems quantitate the proportion of patients who need and actually receive follow-up care after the index AKI or AKD hospitalization. The intensity and appropriateness of follow-up care should depend on patient characteristics, severity, duration, and course of AKI of AKD, and should evolve as evidence-based guidelines emerge. Quality indicators for discharged patients with dialysis requiring AKI or AKD should be distinct from end-stage renal disease measures. Besides, there should be specific quality indicators for those still requiring dialysis in the outpatient setting after AKI or AKD. Given the limited preexisting data guiding the care of patients after an episode of AKI or AKD, there is ample opportunity to establish quality measures and potentially improve patient care and outcomes. This review will provide specific evidence-based and expert opinion-based guidance for the care of patients with AKI or AKD after hospital discharge.

Keywords: acute kidney injury; outcomes; quality; recovery.

Publication types

Review