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

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