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AKI Guide

Foreword

This document has been developed in conjunction with the UK Kidney Association’s multi-professional Acute Kidney Injury Special Interest Group. It builds on the ‘Think Kidneys’ campaign resources from the preceding decade and consolidates these with more recent conceptual updates and resources.

It aims to support modern healthcare professionals to prevent, identify, manage and mitigate the clinical syndrome of acute kidney injury (AKI), as well as to reduce associated risks at both the individual and organisational level. The vast majority of AKI is detected and managed by non-specialist clinicians, and the content is intended to be accessible to healthcare professionals from across the multi-professional team who are working in hospital, community, or primary care settings.

This document is not intended as a clinical guideline, nor as a reproduction of the UKKA AKI National Summit Recommendations (2024). Instead, it is designed as a practical hub: it summarises key concepts and actions, and directs readers to further guidance and resources where deeper detail is needed.

Disclaimer

To the best of our knowledge, the contents of this publication align with National Institute for Health and Care Excellence guidance relating to the prevention, detection, and management of acute kidney injury at the time of publication.

Professional advice should be sought before taking, or refraining from taking, any action on the basis of the content of this publication. The UK Kidney Association cannot be held responsible for any errors or omissions, or for any consequences arising from reliance on the information contained within this publication by you or any third party who may be informed of its contents.

The UK Kidney Association disclaims all liability and responsibility arising from any reliance placed on the information contained in this publication.

Document map

This guide is organised into the following sections, each addressing a different aspect of AKI care:

  • Background
    Core concepts, definitions, terminology, and context for understanding AKI as a clinical syndrome across care settings.
  • Medication Considerations
    Medicines optimisation across the AKI pathway, including guidance on interpreting kidney function and potassium changes, re-starting treatment after AKI, and the UKKA position statement on “sick day” guidance.
  • Primary Care
    Practical guidance for recognising and responding to AKI in the community, including interpretation of AKI warning stage results, structured assessment, safety-netting, prioritising follow-up, discharge checklists, and patient resources.
  • Secondary Care
    In-hospital foundations for AKI care, including detection and alerting, national reporting and dashboards, assessment of risk, timing of review, use of care bundles, and principles of fluid therapy.
  • Paediatrics
    Guidance for babies, children, and young people (BCYP), including paediatric reference ranges, AKI recognition and staging, risk groups, prevention and management, medicines optimisation, and contrast-associated AKI considerations.
  • Nutritional Considerations
    An overview of the role of nutrition in AKI care, highlighting nutritional risk, principles of assessment, and when specialist dietetic input is required, particularly in acute illness and during kidney replacement therapy.

Acknowledgements

The UK AKI Guide was developed and updated by the AKI Special Interest Group of the UK Kidney Association.

In developing the Guide, the group drew on and synthesised the content of AKI materials created under the auspices of the Think Kidneys Programme, which ran primarily from 2015–2017 and was led by the UK Renal Registry and the Kidney Quality Improvement Partnership at the time, in partnership with many other groups. In some cases, content has been updated from past Think Kidneys materials; in others, multiple materials have been consolidated or synthesised to streamline.

The 2026 update was conducted by:

  • Medication considerations: Clare Morlidge, Matthew Cooke, UK Renal Pharmacy Group
  • Primary care: Jonathan Murray, Thomas Blakeman
  • Secondary care: David Green, Becky Bonfield
  • Babies, children, and young people (BCYP): Stephen McWilliam, Kay Tyerman, Zainab Arslan, Peter Foxon, British Association for Paediatric Nephrology
  • Nutrition considerations: Bruno Mafrici, Williams H, and Edel J

For more detailed information, please see below.

  • Authors and reviewers of 2026 update:
    • Clare Morlidge
    • Matthew Cooke
    • UK Renal Pharmacy Group
  • This section of the AKI Guide supersedes and consolidates the following Think Kidneys documents:
    • “Sick day” guidance in patients at risk of Acute Kidney Injury: Position Statement from the Think Kidneys Board (Originally published: January 2020)
    • Changes in kidney function and serum potassium during ACEI/ARB/diuretic treatment in primary care (Originally published: October 2017)
    • When or if to re-start ACEI, ARB, diuretics and other antihypertensive drugs after an episode of Acute Kidney Injury (Originally published: November 2018)
    • Acute Kidney Injury – potentially problematic drugs and actions to take in Primary Care (Originally published: No date)

  • Authors and reviewers of 2026 update:
    • Jonathan Murray
    • Thomas Blakeman
  • This section of the AKI Guide supersedes and consolidates the following Think Kidneys documents:
    • Acute Kidney Injury: Best Practice Guidance – Responding to AKI Warning Stage Test Results for Adults in Primary Care (Originally published: April 2016)
    • Acute Kidney Injury: Recommended Response Times to AKI Warning Stage Test Results for Adults in Primary Care (Table 1) (Originally published: 2016)
    • Recognising and Responding to Acute Kidney Injury in Primary Care (Table 2) (Originally published: 2016)
    • Quick Reference Guide: Could My Patient Have Acute Kidney Injury? (Originally published: 2016)
    • Responding to AKI Warning Stage Test Results for Adults in Primary Care (Originally published: April 2016)
    • Discharge Summaries for Patients Whose Hospital Admission Included an Episode of Acute Kidney Injury: Minimum Data Content (Originally published: March 2016)
    • Primary Care Best Practice Guidance for Acute Kidney Injury (Originally published: 2016)

  • Authors and reviewers of 2026 update:
    • David Green
    • Becky Bonfield
  • This section of the AKI Guide supersedes and consolidates the following Think Kidneys documents:
    • Recommended Minimum Requirements of a Care Bundle for Patients with Acute Kidney Injury (AKI) in Hospital (Originally published: December 2015)
    • Acute Kidney Injury: Risk and Prevention Guidance for Secondary Care (No date)

  • Authors and reviewers of 2026 update:
    • Stephen McWilliam
    • Kay Tyerman
    • Zainab Arslan
    • Peter Foxon
    • British Association for Paediatric Nephrology
  • This section of the AKI Guide supersedes and consolidates the following Think Kidneys documents:
    • Guidance for clinicians managing children at risk of, or with, acute kidney injury (Originally published: May 2016)
    • BAPN AKI Management Recommendations (No date)
    • Managing children with Acute Kidney Injury in primary care (October 2017)

  • Authors and reviewers of the 2024 update:
    • Bruno Mafrici, Clinical Specialist Renal Dietitian, non-medical prescriber, Dietetic and Nutrition Department, Therapy Services, Renal and Transplantation Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
    • Williams H, Betsi Cadwaladr University Health Board, Bangor, Wales, UK
    • Edel J, Critical Care Specialist Dietitian

Inclusion in this list reflects historical involvement in, association with, or contribution to the Think Kidneys Programme or its outputs at the time they were produced. The level and nature of involvement varied. Inclusion does not imply review, endorsement, authorship, approval, or ongoing association with the current UKKA AKI Guide or any related materials. This acknowledgement recognises legacy association only.

  • Contributors to the Think Kidneys Programme included (authors, reviewers, and other contributors): Saeed Ahmed, Learieann Alexander, Saifuddin Zahed Chowdhury, Syed Ashraf, Caroline Ashley, Helen Baxter, Julie Baker, Alastair Bateman, Graham Bayly, Peter Beresford, Richard Blakey, Tom Blakeman, Becky Bonfield, Mike Bosomworth, Peter Brindle, Liz Butterfield, Fergus Caskey, Sue Carr, Stephen Campbell, Tim Chesworth, Martin Christian, Jude Clark, Ron Cullen, Fiona Cummings, Lesli Davies, Ben Davies, Stephen Dickinson, Melanie Dillon, Christopher Dykes, Leonard Ebah, Chris Farmer, Elizabeth Fisher, Richard Fluck, Lui Forni, Peter Goyder, Kathryn Griffith, Patricia Hargrave, Sarah Harding, Charles Heatley, Wesley Hayes, Yvonne Higgins, Robert Hill, Helen Hobbs, Jeremy Horwood, Clair Huckerby, Coral Hulse, David Hughes, Alyson Huntley, Carol Inward, Linda Hunter, Mike Jones, Nigel Jones, Suren Kanagasundaram, Edward Kingdon, Chris Laing, James Larcombe, Dan Lasserson, Caroline Lecko, Rachel Lennon, Trina Leskiw, Andy Lewington, Fiona Loud, Andrew Lunn, Kathryn E. Mansfield, Anna-Marie Martindale, James McCann, Fin McCaul, Isla McDonald, David Milford, Matt Morgan, Chris Mulgrew, Jonathan Murray, Andrew Narva, Peter Naish, Dorothea Nitsch, Rob Nipah, Michael Oliver, Marlies Ostermann, Rajib Pal, Stewart Pattman, Aled Phillips, Dimitrios Poulikakos, Sarah Purdy, Shipra Rao, Andy Richards, Paul Roderick, Nigel Rowell, Joan Russell, Jelena Savović, Nick Selby, Gillian M. Shenfield, Sue Shaw, Rukshana Shroff, Manish Sinha, Sanjay Sinha, Smeeta Sinha, Julie Slevin, Liam Smeeth, Claire Stocks, Catherine Stirling, Tom Stone, Annie Taylor, Michael Taylor, Nigel Taylor, Hong Thoong, Peter Thomson, Charlie Tomson, Laurie A. Tomlinson, Kay Tyerman, Jung Yin Tsang, Emma Vaux, Richard Venn, Teresa Wallace, Winnie Wade, Sean Watters, Penny Whiting, Harriet Williams, Bob Winter, Michael Wise, Johanna Wookey, Gang Xu.
  • Partner organisations associated with the Think Kidneys Programme included: NHS England, UK Renal Registry, Kidney Quality Improvement Partnership, UK Kidney Association, Royal College of General Practitioners, Royal College of Physicians, Society for Acute Medicine, British Society for Heart Failure, British Geriatrics Society, Intensive Care Society, Faculty of Intensive Care Medicine, Association of Nephrology Nurses, UK Renal Pharmacy Group, Association for Laboratory Medicine, UK National External Quality Assessment Services – Clinical Chemistry, National Institute for Health and Care Excellence, Academic Health Science Networks, Renal Association, British Renal Society, London Acute Kidney Injury Network, Derby Teaching Hospitals NHS Foundation Trust, North East and North Cumbria Academic Health Science Network (AKI Collaboration), Royal Berkshire NHS Foundation Trust, Royal Devon and Exeter NHS Foundation Trust, Medway NHS Foundation Trust, NHS Highland, North Staffordshire Combined Healthcare NHS Trust, Plymouth Hospitals NHS Trust, Abertawe Bro Morgannwg University Health Board, York Teaching Hospital NHS Foundation Trust.
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