{"doi":"10.1681/asn.2020040397","title":"Improving Care for Patients after Hospitalization with AKI","abstract":"AKI and CKD are interconnected syndromes with common outcomes, including progressive CKD, cardiovascular events, poor quality of life, and death.1 However, outpatient care after AKI is often fragmented, with limited evidence to inform care recommendations. These observations prompt the question, “Can changes in care after an episode of AKI reduce these risks?” The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened a workshop on January 30 and 31, 2019, that included a multidisciplinary group of clinicians, scientists, and other stakeholders. Participants were tasked with identifying potential gaps in care after AKI, populations at risk, outcomes of interest, potential interventions, and possible trial designs. In light of NIDDK initiatives to include patient voices in all aspects of clinical research, ranging from suggesting content areas to participation in Steering Committees, Safety Monitoring Boards, and the planning, conduct, and reporting of clinical trials,2 a panel of patients who experienced AKI was invited to participate in the workshop. Speaker Session Synopses What Clinical Outcomes following Discharge after an AKI Hospitalization May Be Modifiable? Several studies have reported a lack of nephrology follow-up after AKI and the potential benefit of such care.3 Given the paucity of therapeutic agents to effect kidney recovery, it is important to define specific elements of care that may improve outcomes. With mechanistic and clinical studies providing strong links between AKI and CKD progression and potentially cardiovascular disease, early discussions centered on identifying intermediate outcomes along these axes. Preclinical studies indicate that AKI can worsen traditional risk factors for CKD and cardiovascular disease, including salt sensitivity of BP and urine protein excretion. Emerging clinical data also demonstrate robust associations between AKI, hypertension, and proteinuria.4,5 Given that cardio- and kidney-protective medications are often discontinued after AKI and that kidney function and proteinuria are infrequently assessed, the lack of timely recognition and management of these risk factors represents a potentially important gap in care. Recurrent AKI, which affects up to 25% of AKI survivors, is another intermediate outcome that can threaten recovery and contribute to faster declines in kidney function.6 Both traditional factors (e.g., CKD and diabetes) and AKI-related factors (e.g., severity) pose risks for AKI recurrence. One potential area for decreasing risk is minimizing nephrotoxic exposures. Quality improvement programs have successfully reduced nephrotoxin exposure in hospitalized patients but have not been extended to outpatient settings. Outpatient providers have a critical role and may not be aware of the associated hazards of AKI nor potential approaches to mitigate risk for further kidney injury. Discharge summaries (when available) may not document that AKI has occurred as AKI may not be prioritized among competing issues. Further, providers may not be aware of the increased risk of nephrotoxins following AKI, such as nonsteroidal anti-inflammatory agents, or that the risk may be heightened when taken concomitantly with renin-angiotensin-aldosterone system (RAAS) inhibitors and diuretics. AKI survivors are also at higher risk for adverse drug events due to poor recognition of changing kidney function, highlighting the need for improved medication reconciliation.7 Lastly, patients themselves may be unaware of their AKI or its consequences. Collectively, these findings suggest a need for approaches to improve awareness and education regarding the minimization of nephrotoxin exposure after AKI among both providers and patients. Other factors potentially affecting recovery or the risk for recurrent AKI include the degree of BP control and RAAS inhibition. Preclinical studies indicate that AKI results in autoregulatory derangements that may increase susceptibil","journal":"Journal of the American Society of Nephrology","year":2020,"id":92204,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":43,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9595,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":108933,"name":"Kathleen D. Liu","orcid":"0000-0003-4891-8649","position":1,"is_corresponding":false},{"id":462533,"name":"John Bonn","orcid":null,"position":2,"is_corresponding":false},{"id":249671,"name":"Vernon M. Chinchilli","orcid":"0000-0001-6488-7809","position":3,"is_corresponding":false},{"id":277168,"name":"Laura M. Dember","orcid":"0000-0002-9735-7473","position":4,"is_corresponding":false},{"id":106789,"name":"Timothy D. Girard","orcid":"0000-0002-9833-4871","position":5,"is_corresponding":false},{"id":58433,"name":"Tom Greene","orcid":"0000-0002-3706-7570","position":6,"is_corresponding":false},{"id":51666,"name":"Adrian F. Hernandez","orcid":"0000-0003-3387-9616","position":7,"is_corresponding":false},{"id":249667,"name":"T. Alp İkizler","orcid":"0000-0002-5717-4218","position":8,"is_corresponding":false},{"id":461359,"name":"Matthew T. James","orcid":"0000-0002-1876-3917","position":9,"is_corresponding":false},{"id":462534,"name":"Kevin Kampschroer","orcid":null,"position":10,"is_corresponding":false},{"id":225761,"name":"Jeffrey B. Kopp","orcid":"0000-0001-9052-186X","position":11,"is_corresponding":false},{"id":462535,"name":"Marla Levy","orcid":null,"position":12,"is_corresponding":false},{"id":108987,"name":"Paul M. Palevsky","orcid":"0000-0002-7334-5400","position":13,"is_corresponding":false},{"id":6676,"name":"Neesh Pannu","orcid":"0000-0002-8626-8504","position":14,"is_corresponding":false},{"id":241229,"name":"Chirag R. Parikh","orcid":"0000-0001-9051-7385","position":15,"is_corresponding":false},{"id":290915,"name":"Michael V. Rocco","orcid":"0000-0003-0544-6071","position":16,"is_corresponding":false},{"id":461360,"name":"Samuel A. Silver","orcid":"0000-0002-1843-6131","position":17,"is_corresponding":false},{"id":249664,"name":"Heather Thiessen‐Philbrook","orcid":"0000-0003-2067-0514","position":18,"is_corresponding":false},{"id":107975,"name":"Ron Wald","orcid":"0000-0003-4411-8169","position":19,"is_corresponding":false},{"id":462536,"name":"Yining Xie","orcid":null,"position":20,"is_corresponding":false},{"id":214519,"name":"Paul L. Kimmel","orcid":null,"position":21,"is_corresponding":false},{"id":461361,"name":"Robert A. Star","orcid":"0000-0003-0940-3079","position":22,"is_corresponding":false},{"id":249668,"name":"Edward D. Siew","orcid":"0000-0003-1343-8784","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-18T22:29:54.256205Z","pmid":"32912935","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}