New guidance on clinical communication after acute kidney injury (AKI) aims to improve interactions between inpatient and outpatient clinicians, as well as communication with patients.

“Our study provides the most developed framework [to date] for conducting thorough post-AKI clinical communication,” lead author Y. Diana Kwong, MD, of the Division of Nephrology at UCSF Medical Center in San Francisco, told Medscape Medical News.

“Systematic communication after AKI can help clinicians carry out recommended care for their patients.”

The guidance, published in the American Journal of Kidney Diseases, was developed by a multidisciplinary consensus panel of 47 experts convened by the American Society of Nephrology Excellence in Patient Care AKINow Recovery workgroup in response to evidence showing substantial gaps in post-AKI discharge communication.

For instance, one study from Johns Hopkins Hospital, Baltimore, reported that fewer than half of AKI events were mentioned in discharge documentation, while another study conducted at Vanderbilt University Medical Center, Nashville, Tennessee, found that 80% of patients with AKI were unaware of their diagnosis at discharge. Notably, 80% of patients also reported wanting more information about AKI.

Gaps in communication between practitioners have also been reported. In one study, only 53% of patient charts documented AKI and included medication adjustment recommendations.

Communication Between Inpatient and Outpatient Care Teams

Citing improved outcomes in oncology with standardized communication protocols that facilitate handoffs from specialist to primary care, the consensus panel sought to develop recommendations to similarly improve post-AKI handoffs.

The panel comprised 33 physicians, including 27 nephrologists; 10 allied health practitioners; and 4 patients and/or caregivers. Using a modified Delphi process, they reached consensus on key issues to address in post-AKI clinical communications.

For communication between inpatient and outpatient healthcare providers, the panel strongly agreed on the need to highlight medication changes and provide accurate descriptions of changes in kidney function during hospitalization.

In particular, “the dialysis start date and last dialysis date should be included when communicating about patients with AKI requiring dialysis,” Kwong said.

When medications are stopped, instructions should clearly indicate whether they should be resumed or avoided in the future, the panel emphasized.

Clinical communication should also address monitoring for kidney recovery and residual kidney damage, with ongoing attention to factors that could increase the risk for kidney disease progression.

Communication With Patients

The panel strongly agreed that clinicians should inform patients about medication changes following an AKI event, including which medications to avoid.

Patients should also be informed about the need for outpatient follow-up testing and monitoring, including preventive measures such as blood pressure monitoring and fluid management.

Follow-up communication should include guidance on postdischarge appointments and provide patients with needed information and resources to learn more about their condition.

For patients with AKI who require dialysis, education should address issues such as preventing catheter infection and the prognosis for possible independence from dialysis.

Downloadable Communication Guide

The publication included a downloadable AKINow Communication Guide in its supplement, outlining the recommendations and providing forms to help track key information for optimizing kidney health and potential recovery after AKI.

The guide was divided into two parts: Part A was designed to facilitate communication between care teams about changes in kidney health during hospitalization, whereas Part B summarized recommended topics for clinicians to review with patients.

In its current form, the guide “is meant to be a template and jumping point for clinicians rather than a gold standard document at this point,” Kwong explained.

However, systematic communication about an AKI event should “ensure that outpatient clinicians know that AKI occurred during a hospitalization and encourage the completion of necessary follow-up tests for patients,” she added.

Overall, “appropriate AKI communication will also aid clinicians in employing the appropriate strategies to optimize renal recovery and mitigate a patient’s increased risk of cardiovascular events, chronic kidney disease progression, and recurrent AKI,” Kwong said.

Kwong had no disclosures to report.