INTRODUCTION:In acute heart failure (AHF), the factors associated with successful renal replacement therapy (RRT) discontinuation are largely undefined. We hypothesized that improvements in Doppler-derived renal venous flow (RVF) waveforms may serve as indicators of recovering cardiorenal function associated with successful liberation from RRT. METHODS:We performed a post hoc analysis of a prospective cohort study involving inpatients with AHF undergoing serial renal Doppler evaluations. Patients who received acute RRT were retained for analysis, with Doppler assessments conducted both before RRT initiation and after discontinuation. Successful RRT discontinuation was defined as RRT cessation without relapse for at least 14 days. Logistic regression was used to evaluate the association between changes in RVF markers - including intra-renal venous flow (IRVF) and the renal venous stasis index (RVSI) - and RRT discontinuation, along with echocardiographic and clinical data from pre- to post-RRT Doppler measurements. RESULTS:Overall, 10/53 (19%) patients successfully discontinued RRT. Increases in the severity of IRVF patterns and RVSI were negatively associated with RRT discontinuation (IRVF per 1-pattern increase in severity: OR 0.01, 95% CI, <0.001-0.11; p < 0.001; RVSI per 0.1-unit increase: OR 0.11, 95% CI, 0.03-0.48; p < 0.001). Additionally, improvements in right ventricular function markers, such as the TAPSE/sPAP ratio (per 0.1 mm/mm Hg increase: OR 1.83, 95% CI, 1.03-3.32; p = 0.049), were associated with higher odds of RRT discontinuation. CONCLUSIONS:In AHF patients requiring acute RRT, improvements in RVF were associated with successful RRT discontinuation. Serial RVF assessment may offer a noninvasive means of capturing dynamic changes in cardiorenal syndrome physiology and renal recovery. Larger studies with more frequent and appropriately timed Doppler assessments are needed to determine whether RVF monitoring may guide RRT management in AHF.

Hypomagnesemia is a frequent and often underrecognized electrolyte disturbance with important clinical consequences, especially in hospitalized and critically ill patients. This multifactorial condition arises from impaired intestinal absorption, renal magnesium wasting, and the effects of various medications. Magnesium, the second most abundant intracellular cation, is crucial in enzymatic and physiological processes; its deficiency is associated with neuromuscular, cardiovascular, and metabolic complications. This narrative review focuses on the mechanisms and clinical consequences of drug-induced hypomagnesemia, highlighting the major drug classes involved such as diuretics, antibiotics, antineoplastic agents, and immunosuppressants. Management strategies include magnesium supplementation and adjunctive therapies like amiloride and SGLT2 inhibitors to reduce renal magnesium losses. Recognizing and addressing drug-induced hypomagnesemia is essential to improve patient outcomes and prevent long-term complications.

Syndrome of inappropriate antidiuresis (SIAD)—the most frequent cause of hypotonic hyponatremia—is mediated by nonosmotic release of arginine vasopressin, which promotes water retention by activating renal vasopressin type 2 (V2) receptors. There are numerous causes of SIAD, including malignancy, pulmonary and central nervous system diseases, and medications. Rare activating mutations of the V2 receptor can also cause SIAD. Determination of the etiology of SIAD is important because removal of the stimulus for inappropriate arginine vasopressin secretion offers the most effective therapy. Treatment of SIAD is guided by symptoms and their severity, as well as the level of plasma sodium. In the absence of severe symptoms, which require urgent intervention, many clinicians focus on fluid restriction as a first-line treatment. Second-line therapeutic options include loop diuretics and salt tablets, urea, and V2 receptor antagonists.

Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9

In the United States, regulatory changes dictate telehealth activities. Telehealth was available to patients on home dialysis as early as 2019, allowing patients to opt for telehealth with home as the originating site and without geographic restriction. In 2020, coronavirus disease 2019 was an unexpected accelerant for telehealth use in the United States. Within nephrology, remote patient monitoring has most often been applied to the care of patients on home dialysis modalities. The effect that remote and virtual technologies have on home dialysis patients, telehealth and health care disparities, and health care providers' workflow changes are discussed here. Moreover, the future use of remote and virtual technologies to include artificial intelligence and artificial neural network model to optimize and personalize treatments will be highlighted. Despite these advances in technology challenges continue to exist, leaving room for future innovation to improve patient health outcome and equity. Prospective studies are needed to further understand the effect of using virtual technologies and remote monitoring on home dialysis outcomes, cost, and patient engagement.

BACKGROUND:Cancer patients are prone to developing acute kidney disease (AKD), yet this phenomenon remains understudied compared to acute kidney injury (AKI). AKD, which often develops insidiously, can cause treatment interruptions, extended hospital stays, and increased mortality. SUMMARY:This perspective article explores the intricate relationship between AKD and cancer, focusing on prevalence, risk factors, implications for anticancer therapy, and long-term outcomes, including chronic kidney disease progression. KEY MESSAGES:To emphasize the importance of early detection and intervention, this work advocates for increased research and awareness among clinicians to improve patient outcomes and manage healthcare burdens associated with AKD in cancer patients.

Accurate assessment of GFR is crucial to guiding drug eligibility, dosing of systemic therapy, and minimizing the risks of both undertreatment and toxicity in patients with cancer. Up to 32% of patients with cancer have baseline CKD, and both malignancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface area adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD Epidemiology Collaboration (CKD-EPI) equations, with 2508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (eight studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the American Society of Onco-Nephrology Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment, we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials.

Chronic Kidney Disease (CKD) and cancer constitute two major public health burdens and are on the rise. Moreover, the number of patients affected simultaneously by both conditions is growing. Potential nephrotoxic effect of cancer therapies is particularly important for patients with CKD, as they are also affected by several comorbidities. Therefore, administering the right therapy at the right dose for patients with decreased kidney function can represent a daunting challenge. We review in detail the renal toxicities of anti-cancer therapies i.e. conventional chemotherapy, targeted therapy, immune checkpoint inhibitors, and radioligand therapies, issue recommendations for patient monitoring along with guidance on when to withdraw treatment and suggest dosage guidelines for select agents in advanced stage CKD. Various electrolytes disturbances can occur as the result of the administration of anti-cancer agents in the patient with decreased kidney function. These patients are prone to developing hyponatremia, hyperkalemia, and other metabolic abnormalities because of a decreased GFR. Therefore, all electrolytes, minerals and acid base status should be checked at baseline and before each administration of chemotherapeutic agents. Moreover, studies on patients on kidney replacement therapy (KRT) are very limited and only single cases or small case series are published. Therefore, clinical therapeutical decisions in cancer patients with decreased function should be made by multidisciplinary teams constituted of medical oncologists, nephrologists, and other specialists. Onconephrology is an evolving and expanding subspecialty. It is crucial to consider anticancer drug treatment in these patients and offer them a chance to be treated effectively.

Background Acute kidney disease (AKD) defines the period after kidney damage and it is a critical period of both repair and fibrotic pathways. However, the outcomes of patients with AKD have not been well-defined.Methods In this meta-analysis, PubMed, Embase, Cochrane and China National Knowledge Infrastructure were searched on July 31,2022. We excluded studies including patients undergoing kidney replacement therapy at enrollment. The data was used to conduct a random-effects model for pool outcomes between patients with AKD and non-AKD (NKD). This study is registered with PROSPERO, CRD 42021271773.Findings The search generated 739 studies of which 21 studies were included involving 1,114,012 patients. The incidence rate of community-acquired AKD was 4.60%, 2.11% in hospital-acquired AKD without a prior AKI episode, and 26.11% in hospital-acquired AKD with a prior AKI episode. The all-cause mortality rate was higher in the AKD group (26.54%) than in the NKD group (7.78%) (odds ratio [OR]: 3.62, 95% confidence interval [CI]: 2.64 to 4.95, p < 0.001, I2 = 99.11%). The rate of progression to end-stage kidney disease (ESKD) was higher in the AKD group (1.3%) than in the NKD group (0.14%) (OR: 6.58, p < 0.001, I2 = 94.95%). The incident rate of CKD and progressive CKD was higher in the AKD group (37.2%) than in the NKD group (7.45%) (OR:4.22, p < 0.001, I2 = 96.67%). Compared to the NKD group, patients with AKD without prior AKI had a higher mortality rate (OR: 3.00, p < 0.001, I2 = 99.31%) and new-onset ESKD (OR:4.96, 95% CI, p = 0.002, I2 = 97.37%).Interpretation AKD is common in community and hospitalized patients who suffer from AKI and also occurs in patients without prior AKI. The patients with AKD, also in those without prior AKI had a higher risk of mortality, and new-onset ESKD than the NKD group.Funding This study was supported by Ministry of Science and Technology (MOST) of the Republic of China (Taiwan) [grant number, MOST 107-2314-B-002-026-MY3, 108-2314-B-002-058, 110-2314-B-002-241, 110-2314-B-002-239], National Science and Technology Council (NSTC) [grant number, NSTC 109-2314-B-002-174-MY3, 110-2314-B-002-124-MY3, 111-2314-B-002-046, 111-2314-B-002-058], National Health Research Institutes [PH-102-SP-09], National Taiwan University Hospital [109-S4634, PC-1246, PC-1309, VN109-09, UN109-041, UN110-030, 111 -2023;55: FTN0011] Grant MOHW110-TDU-B-212-124005, Mrs. Hsiu-Chin Lee Kidney Research Fund and Chi-mei medical center CMFHR11136. JAN is supported, in part, by grants from the National Institute of Health, NIDDK (R01 DK128208 and P30 DK079337) and NHLBI (R01 HL148448-01).Copyright (c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The authors regret that there was an error in Figure 1 of the above published article. In this figure, the second yellow box from the top reads "Creatinine Phosphate," while it should read "Creatine phosphate." The corrected version of the figure is below. The authors apologise for any inconvenience caused. Creatinine: From physiology to clinical applicationEuropean Journal of Internal MedicineVol. 72PreviewEstimating static kidney function accurately and detecting changes in kidney function in a timely fashion are challenging and critically important. Full-Text PDF

Magnesium disorders are common in clinical practice and when present can manifest clinically as cardiovascular, neuromuscular, or other organ dysfunction. Hypomagnesemia is far more common than hypermagnesemia, which is largely seen in patients with reduced glomerular filtration rates receiving magnesium-containing medications. In addition to inherited disorders of magnesium handling, hypomagnesemia is also seen with excessive gastrointestinal or renal losses and due to medications such as amphotericin B, aminoglycosides, and cisplatin. Laboratory assessment of body magnesium stores largely relies on the measurement of serum magnesium levels that are a poor proxy for total body stores but does correlate with the development of symptoms. Replacement of magnesium can be challenging, with oral replacement strategies being generally more effective at slowly replacing body stores but intravenous replacement being more effective at treating the more life-threatening and severe cases of hypomagnesemia. We conducted a thorough review of the literature using PubMed (1970-2022) and the search terms magnesium, hypomagnesemia, drugs, medications, treatment, and therapy. In the absence of clear data on optimal management of hypomagnesemia, we have made recommendations on magnesium replacement based on our clinical experience.

Background The impact of changes in Doppler‐derived kidney venous flow in heart failure (HF) is not well studied. We aimed to investigate the association of Doppler‐derived kidney venous stasis index (KVSI) and intrakidney venous‐flow (IKVF) patterns with adverse cardiorenal outcomes in patients with HF. Methods and Results In this observational cohort study, consecutive inpatients with HF referred to a nephrologist because of a history of diuretic resistance and abnormal kidney function (n=216) underwent spectral kidney assessments after admission (Doppler 1) and 25 to 35 days later (Doppler 2) to identify IKVF patterns (continuous/pulsatile/biphasic/monophasic) and KVSI levels. Cox proportional hazard regression models were used to evaluate the associations between KVSI/IKVF patterns at Doppler 1 as well as changes from Doppler 1 to Doppler 2 and risk of cardiorenal events up to 18 months after admission. Worsening HF or death occurred in 126 patients. Both baseline KVSI (hazard ratio [HR], 1.49 [95% CI, 1.37–1.61] per 0.1‐unit increase) and baseline IKVF pattern (HR, 2.47 [95% CI, 2.01–3.04] per 1 pattern severity increase) were significantly associated with worsening HF/death. Increases in both KVSI and IKVF pattern severity from Doppler 1 to 2 were also associated with an increased risk of worsening HF/death (HR, 3.00 [95% CI, 2.08–4.32] per 0.1‐unit increase change; and HR, 6.73 [95% CI, 3.27–13.86] per 1 pattern increase in severity change, respectively). Similar results were observed for kidney outcomes. Conclusions Baseline kidney venous flow predicted adverse cardiorenal events, and inclusion of serial kidney venous flow in cardiorenal risk stratification could facilitate clinical decision‐making for patients with HF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03039959.

Most patients with kidney failure in the United States are dependent on large for-profit corporations for dialysis treatments. For most patients, this care is paid for by the Centers for Medicare & Medicaid Services (CMS) through the End-Stage Renal Disease (ESRD) program, creating in essence a huge flow of US taxpayer dollars to these two corporations and their stockholders (both are traded on the New York Stock Exchange). With such a large amount of these companies' revenue derived from US taxpayers, we believe that these corporations have an obligation to the public to ensure that corporate behaviors and use of these revenues are aligned with improving health outcomes and the lives of patients. While outcomes for patients with kidney failure have improved over the past decade, there is still room for improvement. Recent data show that there was a >25-year projected lifespan difference between men receiving dialysis compared with men in the general population and a >30-year lifespan difference among women.1 Patients on dialysis experience high symptom burdens that negatively affect quality of life.2 Access to therapies that have benefits, such as transplantation and home dialysis, varies widely, with important geographic, racial, economic, and other disparities.3 Efforts to improve outcomes have led to modest success. Models have been designed to provide financial incentives for dialysis facilities and nephrologists to improve outcomes for patients (and financial penalties for failure to do so).4 As of yet, these efforts have not dramatically improved the health of patients with kidney failure. The cost of dialysis in the United States is staggering. In 2022, the Medicare program alone (i.e., excluding payments by commercial insurers) was expected to pay an estimated $8.8 billion to the owners of approximately 7700 dialysis facilities in the United States for dialysis services. With DaVita and Fresenius having a combined market share of approximately 70%–75% of all US dialysis treatments, most of these dollars go to these two for-profit corporations. For 2021, approximately 90% of all dialysis patients treated at DaVita facilities were covered under some form of government-based program, with approximately 75% covered under Medicare and Medicare Advantage Programs.5 US dialysis revenues represent 91% of consolidated revenues for DaVita, 68% of which is derived from US taxpayer government-based programs.5 Fresenius generates approximately 68% of its revenue from the United States, with the majority accounted for by CMS payments.6 In health care settings, corporate behaviors can conflict with the best interests of patients; we believe that a high standard for corporate behavior and investment in patient care should be placed on all such companies, and even more so upon those so largely supported by taxpayer dollars. One might ask whether these and other dialysis corporations have committed sufficient resources to improve outcomes and eliminate disparities among the patients they treat and whether they have adequately invested in dialysis innovation and research to ensure that patients receive the best care possible. Freeman detailed the stakeholder theory of organizational management and business ethics that addresses morals and values in managing an organization and stresses the “interconnected relationships between a business and its customers, suppliers, employees, investors, communities and others who have a stake in the organization.”7 The theory argues that a firm should create value for all stakeholders, not just shareholders. In this case, the expectation of patients as central stakeholders should be on corporate behaviors and investments that significantly improve their quality of life and health outcomes, foster innovation, and promote home dialysis and transplantation. Clinicians, as stakeholders, should also expect investment in tools and staffing (quantity and quality) that maximize outcomes. Staff, as stakeholders, should expect fair wages, reasonable working hours, safe working conditions, and input into their work environment. However, much of the emphasis of modern corporations is focused on increasing shareholder value through efforts to hold down labor and other costs, becoming more vertically integrated to capture as much dialysis-related revenue as possible, ensuring maximum dialysis facility utilization, closure of insufficiently profitable facilities, and through financial maneuvers such as acquisitions and stock buybacks. In recent years, there has also been migration upstream to engage patients with CKD who are not on dialysis. In 2021, DaVita had an operating income of $1797 billion, of which $407 million was invested in acquisitions and development and $1.546 billion was spent on repurchases of nearly 14 million shares of their common stock, which reduced the outstanding share amounts by 11%.5 Critiques of stock buybacks have included (1) that they artificially increase the earning per share and short-term stock valuations and can thus mask financial problems, and (2) companies can use buybacks as a way to allow executives to take advantage of stock option programs. Some economists argue that using excess cash to buy up stocks in the open market is the opposite of what companies should be doing, which is reinvesting to facilitate growth (as well as job creation and training) or, in the case of health care, investing to support research and programs that aim to better support patients. Consider that the current National Institutes of Health funding for kidney disease research is approximately $660 million, less than half of what DaVita spent on stock buybacks in 2021.8 If, for example, only 20% of dialysis corporation profits had instead been reinvested to support kidney research, it is likely that significant advances in the treatment of kidney failure could have been achieved. Another area of concern is the large compensation packages of senior executives at these dialysis corporations. DaVita reported that their chief executive officer (CEO) received a compensation of $73.4 million as of June 2021, which includes a 5-year equity grant.5 The equity grant is not guaranteed, but is based on meeting specific benchmarks over time. However, other reports list his compensation at $3.29 million, which goes to the difficulty in ascertaining executive compensation that may include stock options or other incentives. The CEO of Fresenius Medical Care AG has been reported to have made €3.93 million in 2020.6 In both cases, it is not clear whether, or how, compensation is tied to outcomes or metrics that are important to patients, dialysis facility staff, and clinicians. Stakeholder theory would argue that CEO compensation should not be completely tied to profits and stock prices but also to outcomes of interest for all stakeholders, patients most importantly. This may be the case to some degree currently, but the metrics to which these CEOs are held accountable by their Boards of Directors are not publicly available. Just as nephrologist compensation is moving toward a larger at-risk component dependent on outcomes and improved value through processes that are highly transparent, we believe that the same approach is warranted for executives of these dialysis companies given their dependence on public payer sources. Currently, many parts of the country are suffering from a shortage of skillful dialysis nurses and patient care technicians because of chronically low pay and difficult working conditions.9,10 While many hospitals have grappled with similar issues, they have been much faster to increase wages and take other steps to ensure minimal disruption of patient care. By contrast, certain regions of the country have been forced to deal with abrupt closure of dialysis facilities, displacing staff and patients and disrupting continuity of care. An investment into developing a strong, sustainable, well-trained workforce by dialysis corporations is essential. Just as hospitals and health care systems are increasingly expected or required to provide essential services and care to patients after a hospital discharge and to identify and address social determinates of health and health disparities in the patients they serve, dialysis facility owners should be expected to do the same. This might take the form of providing nutritional support, assisting with internet access, offering more home-based and telehealth services, and/or providing programs to help patients remain employed or gain new employment (and bring greater flexibility into dialysis scheduling to make it easier for patients to be employed). Of course, these programs would require careful legal and regulatory review to ensure compliance with applicable laws, but there is no doubt that much more can be done to support and improve the lives of this vulnerable patient population. Dialysis corporations are in a unique position to do so, and we believe they have a moral obligation to do so. Thus, we advocate for a holistic look at large dialysis organizations with the lens of stakeholder theory and greater responsibility to tax payers and the patients who rely on their services to sustain life. We believe that DaVita and Fresenius must rebalance how they prioritize their stakeholders versus their shareholders, with (1) greater investment in meaningful research, education, technological advancements, and patient support; (2) more focus on developing and sustaining a highly skilled and dependable workforce across the full spectrum—patient-care technicians, nurses, social workers, dieticians, water-treatment specialists, etc.—and on creating a better environment for these individuals to perform their important work; (3) commitment of significant resources to increasing access to kidney transplantation and use of home dialysis and to addressing the social determinants of health of the patients they serve; and (4) greater transparency around compensation for CEOs and other senior executives, with compensation tied to important patient outcomes. Even a modest movement of money away from executive compensation, shareholder profits, and practices, such as stock buybacks, would markedly improve the lives of patients treated with dialysis. No doubt some (many) in the dialysis industry will object to our comments, perhaps citing such things as fiduciary responsibilities to shareholders, declining patient volumes, rising labor costs and staffing shortages, inadequate reimbursements, anti-kickback, and other legal constraints. We sincerely acknowledge and deeply respect the hard work and outstanding care that is provided by staff in dialysis facilities all across the country every day. However, at the end of the day, DaVita and Fresenius derive most of their revenue from US taxpayers, hence owe it to those taxpayers to address the issues and societal obligations discussed.

A hallmark of chronic kidney disease is the retention of solutes that normally are eliminated by the kidneys. The current classification defines uremic toxins based on molecular weight and protein affinity. The retention of solutes is already detected in the early stages of the disease when patients are pauci-symptomatic or asymptomatic but the role of therapies to retard the loss of kidney function in patients with chronic kidney disease (e.g., modulators of the renin-angiotensin-aldosterone system, sodium-glucose cotransporter inhibitors) in reducing uremic toxins is poorly understood. Most of the research evaluating the impact of therapies to lower serum concentrations of those toxic compounds is carried out in patients with kidney failure already undergoing kidney replacement therapy. The removal of those molecules relies in physicochemical mass transfer phenomena, i.e., adsorption, diffusion, and convection. In the past 2 decades, the rise and broad adoption of blood purification strategies with enhanced convective properties, such as high-volume online hemodiafiltration and expanded hemodialysis, considerably amplified the ability to mechanically extract middle molecules (molecular weight >0.5 kDa) from the blood compartment. Nonetheless, the classification of uremic toxins has not evolved in parallel with dialysis advancements. Mounting evidence demonstrates the link between middle molecules with uremic symptoms, cardiovascular and mortality risks. An urgent need for updating the classification exists. Defining the causative relationship between specific solutes and specific clinical outcomes will promote the development of targeted therapies. In parallel, the inclusion of new pertinent dimensions to the classification like the influence of new dialysis membranes, sorbents, and intestinal chelators in the concentration of uremic toxins would improve the understanding of the pathogenesis of chronic kidney disease, setting the pace for future research in nephrology.

Acute kidney injury (AKI), which is a common complication of acute illnesses, affects the health of individuals in community, acute care and post-acute care settings. Although the recognition, prevention and management of AKI has advanced over the past decades, its incidence and related morbidity, mortality and health care burden remain overwhelming. The rapid growth of digital technologies has provided a new platform to improve patient care, and reports show demonstrable benefits in care processes and, in some instances, in patient outcomes. However, despite great progress, the potential benefits of using digital technology to manage AKI has not yet been fully explored or implemented in clinical practice. Digital health studies in AKI have shown variable evidence of benefits, and the digital divide means that access to digital technologies is not equitable. Upstream research and development costs, limited stakeholder participation and acceptance, and poor scalability of digital health solutions have hindered their widespread implementation and use. Here, we provide recommendations from the Acute Disease Quality Initiative consensus meeting, which involved experts in adult and paediatric nephrology, critical care, pharmacy and data science, at which the use of digital health for risk prediction, prevention, identification and management of AKI and its consequences was discussed.