TY - JOUR T1 - Acute kidney injury in primary care: where are we now and where are we going? JF - British Journal of General Practice JO - Br J Gen Pract SP - 394 LP - 395 DO - 10.3399/bjgp17X692225 VL - 67 IS - 662 AU - James Tollitt AU - Lauren Emmett AU - Sheila McCorkindale AU - Emma Flanagan AU - Donal O’Donoghue AU - Smeeta Sinha AU - Dimitrios Poulikakos Y1 - 2017/09/01 UR - http://bjgp.org/content/67/662/394.abstract N2 - Acute kidney injury (AKI) is defined as ‘a clinical and biochemical diagnosis reflecting abrupt kidney dysfunction’.1 AKI is graded on a scale of 1–3 based on the size of the creatinine increase from baseline. Higher AKI scores are associated with higher mortality, longer length of stay, and less renal recovery.2AKI complicates almost one in five hospital admissions and is associated with a 20–33% mortality rate, increased length of hospital stay, and an estimated annual cost to the NHS in England of £1.02 billion.3 Two-thirds of AKI cases identified in hospital start in the community.2 NHS England and the UK Renal Association Renal Registry’s Think Kidneys programme have supported changes and improvement in AKI identification, measurement, risk assessment, and education across UK health care including the implementation of a national electronic system that alerts clinicians to potential cases of AKI.1Around 60% of all patients with AKI identified in hospital have it when they reach hospital.2 The mortality of these patients with community-acquired AKI detected in hospital (CAH-AKI) is 19.6% during hospitalisation, which increases to an alarming 45% 14 months post-discharge.4 Although CAH-AKI has a lower mortality rate than hospital-acquired AKI, CAH-AKI represents a noteworthy risk factor for death.The incidence of community-acquired AKI detected in primary care (CAP-AKI) varies according to the use of different AKI definitions and different methodologies for acquiring a baseline creatinine. Sawhney et al5 used the official NHS AKI algorithm and reported that 1.4% of 50 835 patients in a Scottish registry who also had a known creatinine … ER -