Table 5.
Post AKI/AKD kidney health care bundle
| Framework | Components |
|---|---|
| KAMPS | |
| Kidney function check | Kidney 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 | |
| Advocacy | Patient and caregiver education about AKI and CKD |
| Communication with other care providers (i.e., general practitioners, dieticians, nurses, pharmacists, and social workers) | |
| Medications | Medication reconciliation, review, and management |
| Specifically discuss risk benefits of ACEI/ARB/MRA/diuretics | |
| Review RENDs and over the counter medications | |
| Pressure | Ensure patient understands BP goals and targets |
| Discuss fluid status, ideal weight, role of diuretics | |
| Sick day protocols | Educate patients on medications that need monitoring during acute illnessesa |
| Consider protocols to withhold KENDs | |
| WATCH-ME | |
| Weight assessment | Discuss dry weight monitoring and permissive hypervolemia |
| Discuss the role for diuretics in maintaining urine output and ideal volume status | |
| Access | Educate 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 | |
| Teaching | Patient 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). | |
| Clearance | Frequent 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 | |
| Hypotension | Patient education and optimization of care to avoid intradialytic about hypotension |
| Education around BP medications administration in the peri-KRT period | |
| Medications | Medication 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.