Background: Almost two-thirds of patients with acute kidney injury (AKI) damage their kidneys whilst in the community. This paper aims to review existing data on incidence, mortality, and morbidity of AKI within the community and explore the evidence base for primary care strategies aimed at reducing incidence and improving early detection and management of AKI. Methods: A literature search was carried out using PubMed; key words including AKI, primary care, community acquired, and electronic alerts (e-alerts) were used to capture relevant data. Results: Incidence of AKI developing in the community is variable between studies due to differences in AKI definition. Community-acquired AKI (CA-AKI) but identified in hospital (CA_H-AKI) is more prevalent than hospital-acquired AKI and increases short- and long-term mortality and length of stay in hospital. CA-AKI identified in primary care is less severe than CA_H-AKI but is associated with increased mortality. The use of e-alerts has good diagnostic accuracy for detecting AKI but their impact on outcomes in secondary care remains uncertain; it is likely that they should be complemented with other interventions to improve management. Evidence has not yet emerged regarding the effects of e-alerts on outcomes in primary care. Conclusion: Given the significance of developing AKI in the community, strategies to aid early detection and promote prevention are warranted. A multifaceted approach combining e-alerts, educational programs, and care bundles across the interface between primary and secondary care has the potential to improve outcomes in the future.

AKI e-alerts in primary care hasten response to AKI 2 and 3 and reduce all-cause mortality. Educational outreach sessions further improve response time.

INTRODUCTIONAcute kidney injury (AKI) is defined as 'a clinical and biochemical diagnosis reflecting abrupt kidney dysfunction'. 1 AKI is graded on a scale of 1-3 based on the size of the creatinine increase from baseline. Higher AKI scores are associated with higher mortality, longer length of stay, and less renal recovery. 2 AKI complicates almost one in five hospital admissions and is associated with a 20-33% mortality rate, increased length of hospital stay, and an estimated annual cost to the NHS in England of £1.02 billion. 3 Two-thirds of AKI cases identified in hospital start in the community. 2 NHS England and the UK Renal Association Renal Registry's Think Kidneys programme have supported changes and improvement in AKI identification, measurement, risk assessment, and education across UK health care including the implementation of a national electronic system that alerts clinicians to potential cases of AKI. 1 AKI IN THE COMMUNITYAround 60% of all patients with AKI identified in hospital have it when they reach hospital. 2 The mortality of these patients with community-acquired AKI detected in hospital (CAH-AKI) is 19.6% during hospitalisation, which increases to an alarming 45% 14 months post-discharge. 4 Although CAH-AKI has a lower mortality rate than hospital-acquired AKI, CAH-AKI represents a noteworthy risk factor for death.The incidence of community-acquired AKI detected in primary care (CAP-AKI) varies according to the use of different AKI definitions and different methodologies for acquiring a baseline creatinine. Sawhney et al 5 used the official NHS AKI algorithm and reported that 1.4% of 50 835 patients in a Scottish registry who also had a known creatinine within 12 months suffered CAP-AKI. They defined CAP-AKI as AKI detected in primary care but not admitted to hospital within the next 7 days. This study showed that patients with CAP-AKI were of similar age but suffered fewer comorbidities than patients with CAH-AKI. Reported mortality rates were 2.6% for CAP-AKI vs. 20.2% for CAH-AKI at 30 days that increased to 17% and 42.3% respectively at 1 year. Interestingly, in 30-day survivors adjusted 5-year mortality for CAP-AKI was not significantly different from CAH-AKI or hospital-acquired AKI.

No abstract