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Table 1 Components of the Acute Kidney Injury Follow-up Clinic for adults and the Acute Kidney Injury Survivor Clinic for children

From: Ambulatory care after acute kidney injury: an opportunity to improve patient outcomes

  Components
Target population Adults and Children
• KDIGO stage 2 AKI and above
Referral process and appointment targets Adults
• Referrals accepted from all hospital units through an electronic or paper referral form
• Weekly audits by clinic staff to identify AKI patients who are not referred to clinic at hospital discharge
• Target appointments within 30 days of hospital discharge
Children
• Twice monthly audits of a local tracking tool to identify patients eligible for follow-up
• Close coordination with primary care providers and sub-specialists so that nephrology follow-up is scheduled on the same day and at the same location as other appointments
• Target appointments within 90 days of hospital discharge
Medical interventions Adults and Children
• Patients see a nephrologist at every clinic visit
• Dedicated recommendation section to indicate medications that should be adjusted and/or stopped
• Medical therapy that is in accordance with established clinical practice guidelines
• Low threshold for referral to other specialists for concordant care of high risk individuals with multiple chronic diseases
• Screen for future management plans (surgery, chemotherapy) that may place patients at high risk for recurrent AKI episodes
Education Adults and Children
• Inform patients at first visit that AKI is associated with accelerated CKD, ESRD, and cardiac events
• Provide patients with a “sick-day” medication list or wallet card
• Send referral notes to the patient’s primary care provider and relevant specialists after each visit, educating them on the long-term prognosis of AKI
Follow-up Adults
• Patients are followed for a minimum of one year
• Patients complete laboratory investigations at least every three months
• Patients are eligible to graduate from the AKI Follow-up Clinic provided they have had no further AKI episode over 12 months and appropriate comorbidity follow-up has been arranged
• At clinic discharge, patients are referred for general nephrology follow-up if their eGFR is under 45 mL/min/1.73 m2 or urine albumin:creatinine ratio over 30 mg/mmol
Children
• No strict discharge criteria
• Cystatin C is used to monitor kidney function, since decreased muscle mass in children renders serum creatinine a less sensitive measure
• Children may be followed for up to five years after the AKI episode
  1. AKI acute kidney injury, CKD chronic kidney disease, eGFR estimated glomerular filtration rate , ESRD end-stage renal disease , KDIGO kidney disease improving global outcomes