Strategies to Enhance Rehabilitation after Acute Kidney Injury in the Developing World

Acute kidney injury (AKI) is independently associated with new onset chronic kidney disease (CKD), end-stage kidney disease, cardiovascular disease, and all-cause mortality. However, only a minority of patients receive follow-up care after an episode of AKI in the developing world, and the optimal strategies to promote rehabilitation after AKI are ill-defined. On this background, a working group of the 18th Acute Dialysis Quality Initiative (ADQI) applied the consensus-building process informed by a PubMed review of English language articles to address questions related to rehabilitation after AKI. The consensus statements propose that all patients should be offered follow-up within three months of an AKI episode, with more intense follow-up (e.g., < one month) considered based upon patient risk factors, characteristics of the AKI event, and the degree of kidney recovery. Patients should be monitored for renal and non-renal events post-AKI, and we suggest the minimum level of monitoring consist of an assessment of kidney function and proteinuria within three months of the AKI episode. Care should be individualized for higher risk patients, particularly patients who are still dialysis-dependent to promote renal recovery. While evidence-based treatments for survivors of AKI are lacking and some outcomes may not be modifiable, we recommend simple interventions such as lifestyle changes, medication reconciliation, blood pressure control, and education, including the documentation of AKI on the patient’s medical record. In conclusion, survivors of AKI represent a high-risk population and these consensus statements should provide clinicians with guidance on the care of patients after an episode of AKI.