AKI in Frailty Patients: How could we assess those at risk of adverse outcomes? An extended Literature Review

Introduction:

Acute Kidney Injury (AKI) is a common acute medical problem that has been identified in practice as having increased risk for patients who also have concurrent frailty (BGS 2021). National and Global strategies (WHO 2020) (NHS 2019) emphasise the importance in integrating care across the healthcare systems with aim to reduce admissions to secondary care. Completing comprehensive geriatric assessments (CGA), that highlight long term care needs and provide a basis for individualizing care plans can help to achieve this goal and reduce adverse outcomes such as increased length of stay, mortality and admission to residential care facilities on discharge.

Method:

A literature search of databases, MEDLINE, CINAHL and PubMed identified 8 studies to review, and each was analysed using a critical appraisal tool and a theme matrix was developed.

Results:

Having a Clinical Frailty Score of more than 5 (Moorhouse, 2009)(Beaubien-Souligny 2021), AKI stage 2 or 3 (Mehta, 2007)(Abdel-Kader 2018), having multiple co-morbidities (Aitken, 2013), presence of electrolyte imbalance (Chou, 2021), polypharmacy (Faber, 2019), and increased time to diagnosis (Abdel-Kader, 2018), are all independent risk factors for adverse outcomes in patients with AKI and frailty. These risks could be categorised into modifiable and non-modifiable risk factors and including assessment of these when completing a CGA and using specific validated outcome measures can aid clinicians on treatment options or modification of care models to reduce the risks of adverse outcomes in the next 12 months following diagnosis.

Conclusion:

Modifiable and Non-Modifiable Risk Factors outlined from our literature search could be in-cooperated into our frailty assessment proforma in order to identify high risk patient groups and improve outcomes. Implementation of AKI risk stratification into CGA proforma could be further evaluated by a quality improvement project in our Acute Frailty Unit to align with national strategies.