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Guidance for post-discharge care following acute kidney injury: An appropriateness ratings evaluation

Lookup NU author(s): Dr Jon Murray, Dr Charlie Tomson



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020, The Authors.Background: Acute kidney injury (AKI) is associated with poor health outcomes, including increased mortality and rehospitalisation. National policy and patient safety drivers have targeted AKI as an example to ensure safer transitions of care. Aim: To establish guidance to promote high-quality transitions of care for adults following episodes of illness complicated by AKI. Design & setting: An appropriateness ratings evaluation was undertaken using the RAND/UCLA Appropriateness Method (RAM). The Royal College of General Practitioners (RCGP) AKI working group developed a range of clinical scenarios to help identify the necessary steps to be taken following discharge of a patient from secondary care into primary care in the UK. Method: A 10-person expert panel was convened to rate 819 clinical scenarios, testing the most appropriate time and action following hospital discharge. Specifically, the scenarios focused on determining the appropriateness and urgency for planning: an initial medication review; monitoring of kidney function; and assessment for albuminuria. Results: Taking no action (that is, no medication review; no kidney monitoring; or no albuminuria testing) was rated inappropriate in all cases. In most scenarios, there was consensus that both the initial medication review and kidney function monitoring should take place within 1-2 weeks or 1 month, depending on clinical context. However, patients with heart failure and poor kidney recovery were rated to require expedited review. There was consensus that assessment for albuminuria should take place at 3 months after discharge following AKI. Conclusion: Systems to support tailored and timely post-AKI discharge care are required, especially in high-risk populations, such as people with heart failure.

Publication metadata

Author(s): Tsang JY, Murray J, Kingdon E, Tomson C, Hallas K, Campbell S, Blakeman T

Publication type: Article

Publication status: Published

Journal: BJGP Open

Year: 2020

Volume: 4

Issue: 3

Print publication date: 01/08/2020

Online publication date: 17/06/2020

Acceptance date: 10/02/2020

Date deposited: 13/01/2021

ISSN (print): 1849-5435

ISSN (electronic): 2398-3795

Publisher: Royal College of General Practitioners


DOI: 10.3399/bjgpopen20X101054


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Funder referenceFunder name
funded through the partnership forming the RCGP Acute Kidney Injury Quality Improvement Project