Table 13.2, Prevention and Management of Acute Kidney Injury in LMICs - Cardiovascular, Respiratory, and Related Disorders

Recommended intervention	Potential benefit
Prevention or management at the community level
Improve access to, and quality of, drinking water and sanitation	Prevent AKI related to diarrheal illness, kidney stones, and volume depletion in strenuous working conditions
Educate health care workers, pharmacists, and general populations about nephrotoxic medications and herbs	Reduce AKI related to heavy NSAID, illegal alcohol, or herbal toxin use
Involve local health care workers in the identification of patients at risk of AKI	Prevent or limit exposure to environmental risk factors for AKI, such as parasites, infection-carrying vectors, and obstetric complications
Educate and train nonphysicians, such as nurses or clinical officers, or non–health professionals to locally manage AKI, especially with telemedicine support	Limit the progression of AKI to more severe stages that require dialysis
Prevention or management at the hospital level
Improve perinatal care at first-level hospitals	Reduce AKI related to peripartum hemorrhage or preeclampsia
Enhance region-specific understanding of common causes of AKI at first- and second-level hospitals	Provide rapid treatment of underlying causes of AKI
Implement protocols for intensive or intermediate care at first- and second-level hospitals	Resolve mild-to-moderate AKI via rapid fluid resuscitation, vasopressor support, and antibiotic administration
Provide training in PD provision for AKI at second-level hospitals	Treat severe AKI by training non-nephrology physicians in PD catheter insertion and prescription; enable wider availability of dialysis for severe AKI
Create referral centers for provision of intermittent or continuous HD for patients in whom PD is contraindicated	Select individuals with severe AKI who need specialized care, and efficiently allocate resources for dialysis

Recommended intervention

Potential benefit

Prevention or management at the community level

Improve access to, and quality of, drinking water and sanitation

Prevent AKI related to diarrheal illness, kidney stones, and volume depletion in strenuous working conditions

Educate health care workers, pharmacists, and general populations about nephrotoxic medications and herbs

Reduce AKI related to heavy NSAID, illegal alcohol, or herbal toxin use

Involve local health care workers in the identification of patients at risk of AKI

Prevent or limit exposure to environmental risk factors for AKI, such as parasites, infection-carrying vectors, and obstetric complications

Educate and train nonphysicians, such as nurses or clinical officers, or non–health professionals to locally manage AKI, especially with telemedicine support

Limit the progression of AKI to more severe stages that require dialysis

Prevention or management at the hospital level

Improve perinatal care at first-level hospitals

Reduce AKI related to peripartum hemorrhage or preeclampsia

Enhance region-specific understanding of common causes of AKI at first- and second-level hospitals

Provide rapid treatment of underlying causes of AKI

Implement protocols for intensive or intermediate care at first- and second-level hospitals

Resolve mild-to-moderate AKI via rapid fluid resuscitation, vasopressor support, and antibiotic administration

Provide training in PD provision for AKI at second-level hospitals

Treat severe AKI by training non-nephrology physicians in PD catheter insertion and prescription; enable wider availability of dialysis for severe AKI

Create referral centers for provision of intermittent or continuous HD for patients in whom PD is contraindicated

Select individuals with severe AKI who need specialized care, and efficiently allocate resources for dialysis

From: Chapter 13, Kidney Disease

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Table 13.2Prevention and Management of Acute Kidney Injury in LMICs

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