TY - JOUR T1 - Acute kidney injury in the community: why primary care has an important role JF - British Journal of General Practice JO - Br J Gen Pract SP - 173 LP - 174 DO - 10.3399/bjgp13X664207 VL - 63 IS - 609 AU - Thomas Blakeman AU - Sarah Harding AU - Donal O’Donoghue Y1 - 2013/04/01 UR - http://bjgp.org/content/63/609/173.abstract N2 - There is mounting evidence that awareness of kidney function is central to the delivery of safe and clinically-effective care, in terms of preventing both cardiovascular events, and progression to established renal failure, with significant impacts on quality of life and healthcare expenditure.1,2 However, the staging of chronic kidney disease (CKD) has not been without controversy, and like all disease classifications has the potential to both structure and constrain the delivery of care.3,4 General practice has played a central role in the identification and management of CKD becoming a routine aspect of care delivery.1,5 Nevertheless, professional uncertainty remains on the merits of disclosure of the early stages of CKD, especially in older people.6 This is reflected in low levels of patient awareness of CKD, with discussions often limited to reassurance.6,7In addition to maintenance of vascular health and prevention of progression of renal disease, another important reason to focus on the delivery of care for people with early stage CKD is its association with acute kidney injury (AKI). This is a syndrome which is common, harmful, and preventable.8,9 The term AKI is a shift away from the previous inconsistent use of the diagnosis of acute tubular necrosis and acute renal failure.8 Furthermore, the classification system highlights that AKI encompasses a spectrum of acute injury from minor changes in kidney function to acute failure requiring renal replacement therapy.8 This is important as it provides an opportunity to consider people at risk and identify people who may benefit from earlier intervention. It also takes into account the evidence that even small, reversible changes in kidney function (as … ER -