Long-term outcomes of acute kidney injury and strategies for improved care

Acute kidney injury (AKI), once viewed predominantly as a self-limited and reversible condition, is now recognized as a growing problem associated with significant risks of adverse long-term health outcomes. Many cohort studies have established important relationships between AKI and subsequent risks of recurrent AKI, hospital re-admission, morbidity and mortality from cardiovascular disease and cancer, as well as the development of chronic kidney disease and end-stage kidney disease. In both high-income countries (HICs) and low-income or middle-income countries (LMICs), several challenges exist in providing high-quality, patient-centered care following AKI. Despite advances in our understanding about the long-term risks following AKI, large gaps in knowledge remain about effective interventions that can improve the outcomes of patients. Therapies for high blood pressure, glycaemic control (for patients with diabetes), renin–angiotensin inhibition and statins might be important in improving long-term cardiovascular and kidney outcomes after AKI. Novel strategies that incorporate risk stratification approaches, educational interventions and new models of ambulatory care following AKI have been described, and some of these are now being implemented and evaluated in clinical studies in HICs. Care for AKI in LMICs must overcome additional barriers due to limited resources for diagnosis and management. An episode of acute kidney injury (AKI) can predispose individuals to a variety of adverse clinical outcomes. In this Review, the authors discuss the potential long-term outcomes of AKI, as well as current and novel strategies to improve the follow-up care of AKI survivors. Key points Acute kidney injury (AKI) is a common and costly clinical syndrome that affects nearly one-quarter of all hospitalized patients worldwide. Although AKI was previously often perceived as a self-limited condition, it is now clear that acute changes in kidney function are associated with long-term consequences, including progression to chronic kidney disease, cardiovascular effects, sustained functional impairment and death. Therapies for blood pressure control, glycaemic control (for patients with diabetes), renin–angiotensin inhibition and statins might be important in improving long-term cardiovascular and kidney outcomes after AKI. Novel strategies for follow-up care, including specialized nephrology care and risk-stratified follow-up, are being evaluated in high-income countries f