Top ten tips to manage patients after acute kidney injury

Despite high mortality, most patients who experience an episode of acute kidney injury (AKI) survive to hospital discharge. These patients are at increased risk for chronic kidney disease (CKD), recurrent AKI, cardiovascular events, hospital readmission, and premature mortality. AKI is causally linked to some of these longer-term outcomes, particularly CKD, but non-causal associations also serve to identify vulnerable patients at higher risk. In both scenarios, there is a role for improved post-discharge AKI care. However, current evidence for how to deliver this is incomplete, and there are knowledge gaps around which interventions are effective, which patients may benefit the most, and the health-economic impact of new care pathways. Current guidelines recommend monitoring kidney function within 3 months of AKI for all patients, which is challenging to implement and fails to account for varying individual patient needs. In this review, we suggest 'top ten tips' that underpin a pragmatic framework for post-AKI care, based on the best available evidence. With a central role for patient engagement and education, these include early follow-up for patients with incomplete renal recovery, structured assessment of kidney function (including urinary albumin: creatinine ratio, and where appropriate, cystatin C), guideline-directed medication optimization (in particular renin-angiotensin-aldosterone-system inhibitors and sodium-glucose co-transporter 2 inhibitors), cardiovascular risk management and consideration of biopsychosocial aspects of recovery. These are supported by clear and actionable discharge communication, and coordination with other specialities and primary care.