AKI and Risk

Who is at Risk?

NICE guideline NG 148 has a section detailing high risk populations who are prone to experiencing an AKI episode. These include, but are not limited to, those with:

• Chronic kidney disease (adults with an estimated glomerular filtration rate [eGFR] less than 60 ml/min/1.73m^2 are at particular risk)
• Heart failure
• Liver disease
• Diabetes
• History of acute kidney injury
• Oliguria (urine output less than 0.5 ml/kg/hour)
• Neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer
• Hypovolaemia
• Use of drugs that can cause or exacerbate kidney injury (such as non‑steroidal anti‑inflammatory drugs [NSAIDs], aminoglycosides, angiotensin‑converting enzyme [ACE] inhibitors, angiotensin II receptor antagonists [ARBs] and diuretics) within the past week, especially if hypovolaemic
• Use of iodine-based contrast media within the past week
• Symptoms or history of urological obstruction, or conditions that may lead to obstruction
• Sepsis
• Deteriorating early warning scores
• Age 65 years or over

What are they at risk of?

It is now known that AKI is not just a bystander during acute illness, rather it is associated with and directly contributes to, worsening illness severity. As such AKI can be used as a marker of illness severity with its presence being an independent risk factor for:

1. Morbidity and mortality
2. Length of hospital stay
3. Critical Care service use
4. Emergency re-admission

These adverse outcomes persist well after an acute episode with post-hospital individuals also experiencing high risk (1). Knowing the risks that AKI brings can directly feed into system wide and individualized strategies of care to help mitigate adverse patient outcomes and inefficient service use.