Conclusions
AKI is a common worldwide problem, which imposes a so far unrecognized global burden. It is necessary to raise awareness of AKI and to equip caregivers and patients with knowledge and tools to identify and adequately manage patients at risk. Efforts to address the problem are hindered by a fractured and sometimes ineffective approach. To a large extent, this is because of late recognition, inappropriate application of new knowledge, and lack of coordination among caregivers and institutions. In many cases, implementation of simple, actionable measures may go a long way to decrease incidence, severity, and death. Positive change will be dependent on progress at all levels, from the health-care worker in the African village to the prominent politician making public health policy. Such an agenda must contain specific recommendations and be adaptable to different contexts:
At the practical level, we propose to develop a toolkit containing simple, immediately applicable measures to ensure early detection and fast action whenever AKI develops.
At the policy level, we propose a series of efforts destined to implement coordinated actions among government and nongovernment agencies, societies, and institutions. Such initiatives should ensure continuity and coordination of such efforts, in the context of larger programs for the management of closely related conditions. For example, there is urgent need to address AKI in the context of ongoing programs combating increasingly prevalent, severe malaria in LMI regions of the world. Raising the awareness of this silent killer will be achieved only by coordinated efforts, involving the global nephrology community and the multiple components of the health-care system in each region of the world.