The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions.
BACKGROUND
Almost two-thirds of patients with acute kidney injury (AKI) damage their kidneys whilst in the community. This paper aims to review existing data on incidence, mortality, and morbidity of AKI within the community and explore the evidence base for primary care strategies aimed at reducing incidence and improving early detection and management of AKI.


METHODS
A literature search was carried out using PubMed; key words including AKI, primary care, community acquired, and electronic alerts (e-alerts) were used to capture relevant data.


RESULTS
Incidence of AKI developing in the community is variable between studies due to differences in AKI definition. Community-acquired AKI (CA-AKI) but identified in hospital (CAH-AKI) is more prevalent than hospital-acquired AKI and increases short- and long-term mortality and length of stay in hospital. CA-AKI identified in primary care is less severe than CAH-AKI but is associated with increased mortality. The use of e-alerts has good diagnostic accuracy for detecting AKI but their impact on outcomes in secondary care remains uncertain; it is likely that they should be complemented with other interventions to improve management. Evidence has not yet emerged regarding the effects of e-alerts on outcomes in primary care.


CONCLUSIONS
Given the significance of developing AKI in the community, strategies to aid early detection and promote prevention are warranted. A multifaceted approach combining e-alerts, educational programs, and care bundles across the interface between primary and secondary care has the potential to improve outcomes in the future.
Department of Renal Medicine, Salford Royal NHS Foundation Trust, Manchester, UK.
Lauren
L
Emmett
James
J
Tollitt
Sheila
S
McCorkindale
Smeeta
S
Sinha
Dimitrios
D
Poulikakos
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D016896:Treatment Outcome
Acute kidney injury; Community-acquired AKI; Electronic alerts; Primary care