Secondary 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 common among hospitalised patients and is frequently a marker of acute illness severity rather than an isolated kidney disorder. In secondary care, AKI often develops in the context of sepsis, haemodynamic instability, major surgery, exposure to nephrotoxic agents, or evolving multi-organ dysfunction. Early recognition, prompt assessment, and timely intervention are therefore central to improving outcomes.
This section focuses on the core foundations of safe, effective in-hospital AKI care. It outlines how AKI is detected and escalated through standardised laboratory alerting systems, how national reporting and dashboards support quality improvement, and how risk can be identified and acted upon in real time. It also addresses expectations for timely clinical review, recognising that delays in assessment and treatment remain a major contributor to avoidable harm.
Given that the majority of AKI episodes in hospital are managed by non-specialist clinicians, emphasis is placed on practical, system-level approaches that support reliable care: clear alerting pathways, concise care bundles, multidisciplinary working, and explicit clinical responsibility—particularly across shift changes and care transitions. Principles of fluid therapy are included to reinforce that intravenous fluids must be guided by careful clinical assessment of volume status and risk of fluid overload.
Together, these elements aim to support consistent, proportionate, and patient-centred AKI care in hospital settings, while also laying the groundwork for safer discharge planning and continuity of care beyond admission.