Prevention of severe acute kidney injury by implementation of care bundles: Some progress but still a lot of work ahead

Abstract

Routine health data, dating from 1990 to 2015, show a dramatic rise in the incidence of acute kidney injury (AKI) in the general population and an apparent increase in acute dialysis (AKI-D) prompting calls for improvement of care in AKI patients. Recent reports suggest flattening of population-based AKI occurrence rates or declining frequencies of AKI or AKI-D in subgroups of high-risk patients with known onset of AKI. These temporal changes in AKI occurrence relate at least in part to the widespread implementation of AKI prevention care bundles. Nevertheless, AKI frequencies and AKI morbidity and mortality remain high. Incorporation of real-time electronic alerts and the use of novel biomarkers in high-risk patients or patients with known onset of AKI may result in further reductions of AKI incidences by early recognition of AKI and by timely conservative management of AKI. There is an urgent need for further treatment options of established AKI.