Primary Care
Unless otherwise stated, guidance in this section applies to adults aged 18 years and over. For specific guidance on caring for babies, children, and young people with AKI, please see the “Paediatrics” section.
Overview
Acute kidney injury (AKI) is a common and serious patient safety issue. It refers to a sudden decline in kidney function over hours to days and most often occurs in the context of acute illness, such as infection, dehydration, or haemodynamic instability. AKI is associated with increased hospitalisation, morbidity, mortality, and long-term risk of chronic kidney disease, making early recognition and timely follow-up essential.
This guide has been developed by the UK Kidney Association (UKKA) to support primary care teams in preventing, recognising, and responding to AKI, and in prioritising safe, proportionate follow-up after an episode of AKI. It builds on learning from the national Think Kidneys programme and aligns with NICE guidance, while signposting to resources for clinicians, patients and carers.
AKI is not a single disease or diagnosis. It is a clinical syndrome that cuts across many conditions and care pathways. Improving AKI care therefore often means strengthening the fundamentals of safe care: timely clinical assessment, appropriate medicines and fluid management, clear communication across care transitions, and targeted follow-up for people at higher risk.
Scope of primary care responsibility
The primary care role in AKI management is centred on early recognition, timely clinical assessment, medicines review, safety-netting, coordination of care, and prioritisation of follow-up. Primary care clinicians play a key role in identifying people at risk, interpreting AKI warning stage results in clinical context, and ensuring appropriate escalation when required.
Management of severe AKI, suspected sepsis, or physiologically unstable patients sits outside the scope of primary care and requires urgent referral to secondary care services.
AKI management should always be aligned with agreed goals of care, including end-of-life or conservative management pathways where escalation may not be appropriate. As individuals approach the end of life, the focus of care should shift toward symptom control rather than long-term prognostic treatment. Deteriorating kidney function is common in this context, and treatments such as diuretics should be used proportionately to relieve distress from fluid overload and other burdensome symptoms.
| Primary care responsibility | Urgent secondary care | Always align with goals of care |
| Early recognition and clinical assessment Interpretation of AKI warning stage results Medicines review and safety-netting Coordinating follow-up after AKI |
Suspected sepsis Severe AKI or rapid deterioration Physiological instability |
Conservative management End-of-life care Symptom-focused decision-making |