Table 4.

Recognition-Action-Result framework for secondary prevention of AKI, including diagnosis and evaluations, limiting duration and severity of AKI, and prevention of avoidable complications associated with AKI

FrameworkDiagnosis and EvaluationLimiting Severity and Duration of AKIPrevention of Avoidable AKI Complications
RecognitionAKI stage-dependent threshold metNephrotoxin or contributing medicationAKI has occurred
Poor hemodynamicsHigh frequency of hyperkalemia in patients with AKI
Cause-specific diagnosis delayedPoor extubation rates in patients with AKI due to volume overload
Adverse drug events
ActionContext-appropriate evaluation“Nephrotoxin stewardship”Improved monitoring for complications (e.g., BMP/bicarbonate/phosphorus measurement)
Physical examinationAsses and optimize hemodynamicsRisk reduction strategies (e.g., reduced potassium intake, unnecessary maintenance fluids, review of appropriate dosing of meds)
HistoryInvasive/noninvasiveManagement of complications (e.g., treatment of hyperkalemia, fluid removal)
Kidney function and injury biomarkersAvoid hyperglycemia
Urine analysisNephrology referral guidelines
Hemodynamic variablesMonitoring of kidney function with serum creatinine and urine output
Radiology and serology tests
Kidney biopsy
Other context-specific tests
ResultsImproved frequency of context-appropriate diagnostic evaluationImproved rates of nephrotoxin alerting/evaluation/discontinuanceProcess (improved monitoring/detection, reduction in unnecessary potassium supplementation, med reconciliation/evaluation)
Improved recognition of cause-specific AKIHemodynamic intervention appliedClinical (reduced incidence of severe hyperkalemia, treatment of severe acidosis pH<7.2, less adverse drug events related to inappropriate drug dosing/selection in AKI)
Improved timeline of cause-specific diagnosis/interventions
Reduced duration and severity of AKI (e.g., maximum stage, length, recovery)
  • BMP, basic metabolic panel.