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 |