Keywords
Acute kidney injury
Medicine
Nephrology
How to Cite
Abstract
Background: Among hospitalized adults in medical settings, delayed recognition and incomplete bundle-based care may contribute to progression, longer hospitalization, and poorer renal recovery. Adherence to AKI care bundles remains inconsistent, in resource-limited hospitals with staffing, workflow, and documentation constraints.
Methods: We conducted a single-center before-and-after improvement audit over two cycles, preceded by a pilot phase that refined case identification and data collection. The source population comprised consecutive adult medical inpatients meeting KDIGO AKI criteria during admission. In cycle one, 120 patients were assessed. The intervention included a paper-based AKI checklist, staff education, nephrotoxin-prescribing prompts, and escalation triggers. A re-audit of 118 patients was performed, followed by a 3-month sustainability review. Process indicators and outcomes were analyzed using methods and compared across cycles. Patients already under active inpatient nephrology care when AKI was identified were included in the overall cohort but excluded from the nephrology-referral denominator.
Results: Baseline compliance was suboptimal across key care domains. The intervention was associated with improved AKI recognition from 65.0% to 87.3%, medication review from 51.7% to 78.0%, and fluid assessment from 48.3% to 76.3% (all p<0.001). It was also associated with a reduction in progression to severe AKI from 33.3% to 23.3%, and a decrease in mean length of stay from 7.9±3.4 to 6.6±3.0 days. Improvements were sustained at 3 months.
Conclusion: A paper-based AKI bundle was associated with improved recognition and care processes, with changes in outcomes, supporting feasibility in resource-limited settings, although causal inference is limited by design. Further multicenter studies are warranted.
References
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Copyright (c) 2026 Muhammad Aamir Iqbal, MBBS, MD, FCPS, Muhammad Saqib, MBBS, MD, Shehr I Yar Khan, MBBS, MD, Suleman Khan, MBBS, MD, Muhammad Sohrab Mushtaq, Fahad Naim, MBBS, FCPS, FRCP, Adam Saeed, MBBS, MD