Establishing a continuum of acute kidney injury – tracing AKI using data source linkage and long-term follow-up: Workgroup Statements from the 15th ADQI Consensus Conference

Ravindra Mehta, Azra Bihorac, Nicholas M. Selby, Hude Quan, Stuart L. Goldstein, John A. Kellum, Claudio Ronco, Sean M. Bagshaw, For the Acute Dialysis Quality Initiative (ADQI) Consensus Group

Acute kidney injury (AKI) is independently associated with the development of chronic kidney disease, endstage kidney disease and increased all-cause and cardiovascular-specific mortality. The severity of the renal insult and the development of multiple AKI episodes increase the risk of occurrence of these outcomes. Despite these long-term effects, only a minority of patients receive nephrologist follow up after an episode of AKI; those that do may have improved outcomes. Furthermore, relatively simple quality improvement strategies have the potential to change this status quo. On this background, a working group of the 15(th) Acute Dialysis Quality Initiative (ADQI) conference applied the consensus-building process informed by review of English language articles identified through PubMed search to address questions related to the opportunities, methodological requirements and barriers for longitudinal follow-up of patients with AKI in the era of electronic health records and Big Data. Four consensus statements answering the key questions identified by the working group are developed. We have identified minimal data elements and potential data sources necessary to trace the natural history of patients from onset of AKI to long-term outcome. Minimum infrastructure and key barriers to achieving these goals are outlined together with proposed solutions.