Table 5.

Post AKI/AKD kidney health care bundle

FrameworkComponents
KAMPS
 Kidney function checkKidney function measurement by serum creatinine or cystatin C; measured GFR or eGFR
Proteinuria/albuminuria
When available consider biomarkers, imaging and other tests as feasible and indicated
 AdvocacyPatient and caregiver education about AKI and CKD
Communication with other care providers (i.e., general practitioners, dieticians, nurses, pharmacists, and social workers)
 MedicationsMedication reconciliation, review, and management
Specifically discuss risk benefits of ACEI/ARB/MRA/diuretics
Review RENDs and over the counter medications
 PressureEnsure patient understands BP goals and targets
Discuss fluid status, ideal weight, role of diuretics
 Sick day protocolsEducate patients on medications that need monitoring during acute illnessesa
Consider protocols to withhold KENDs
WATCH-ME
 Weight assessmentDiscuss dry weight monitoring and permissive hypervolemia
Discuss the role for diuretics in maintaining urine output and ideal volume status
 AccessEducate patients about the care of central venous catheters
Vein preservation protocols/awareness
When appropriate begin to plan and educate about the role of arteriovenous access and other KRT modalities
 TeachingPatient and caregiver education about dialysis requiring AKD and short- and long-term risks and consequence
Communication with other care providers (e.g., general practitioners, dieticians, nurses, pharmacists, and social workers) about patient needs (e.g., alterations in medication regimens in the setting of new KRT).
 ClearanceFrequent assessments of underlying kidney function (via predialysis laboratory tests or timed clearances)
Frequent assessments of the quality of the KRT being provided to ensure adequate clearance
 HypotensionPatient education and optimization of care to avoid intradialytic about hypotension
Education around BP medications administration in the peri-KRT period
 MedicationsMedication reconciliation, review, and management
Specifically discuss risk benefits of ACEI/ARB/MRA
Review KENDs and over the counter medications
  • AKD, acute kidney disease; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; MRA, mineralocorticoid receptor antagonists; KEND, kidney eliminated and nephrotoxic drugs; KRT, kidney replacement therapy.

  • a Patient education should include but not limited to the signs of AKI recurrence or CKD progress, potential need for future dialysis modalities and its alternatives, information about their medications, and contact information for the clinicians in case of question.