title: Ambulatory care after acute kidney injury: an opportunity to improve patient outcomes.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is an increasingly common problem among hospitalized patients. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, outpatient follow-up with a nephrologist within 90 days of hospital discharge has been associated with enhanced survival. However, most patients who survive an AKI episode do not receive any follow-up nephrology care. This narrative review describes the experience of two new clinical programs to care for AKI patients after hospital discharge: the Acute Kidney Injury Follow-up Clinic for adults (St. Michael's Hospital and University Health Network, Toronto, Canada) and the AKI Survivor Clinic for children (Cincinnati Children's Hospital, USA).
  
  
  METHODS
  MEDLINE, PubMed, ISI Web of Science.
  
  
  RESULTS
  These two ambulatory clinics have been in existence for close to two (adult) and four (pediatric) years, and were developed separately and independently in different populations and health systems. The components of both clinics are described, including the target population, referral process, medical interventions, patient education activities, and follow-up schedule. Common elements include targeting patients with KDIGO stage 2 or 3 AKI, regular audits of the inpatient nephrology census to track eligible patients, medication reconciliation, and education on the long-term consequences of AKI.
  
  
  CONCLUSIONS
  Despite the theoretical benefits of post-AKI follow-up and the clinic components described, there is no high quality evidence to prove that the interventions implemented in these clinics will reduce morbidity or mortality. Therefore, we also present a plan to evaluate the adult AKI Follow-up Clinic in order to determine if it can improve clinical outcomes compared to patients with AKI who do not receive follow-up care.
  
  
  CONCLUSIONS
  Follow-up of AKI survivors is low, and this review describes two different clinics that care for patients who survive an AKI episode. We believe that sharing the experiences of the AKI Follow-up Clinic and AKI Survivor Clinic provide physicians with a feasible framework to implement their own clinics, which may help AKI patients receive outpatient care commensurate with their high risk status.
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.|Present Address: 190 King Edward Avenue, Toronto, ON M4C 5J8 Canada.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Silver
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, OH USA.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.|Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Harel
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Harvey
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, OH USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Rompies
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
authors.forename: Neill K
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: Division of Nephrology, Western University, London, Canada.
authors.forename: Rey
authors.initials: R
authors.lastname: Acedillo
authors.affiliation: Division of Nephrology, Western University, London, Canada.
authors.forename: Arsh K
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Division of Nephrology, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Richardson
authors.affiliation: Division of Nephrology, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.affiliation: Divison of Nephrology, Stanford University School of Medicine, Palo Alto, CA USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada.|Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Wald