Automated alerts for acute kidney injury warrant caution

As an academic renal trainee and apprentice of acute kidney injury (AKI), I have had the privilege of learning my art in parallel with a paradigm shift in diagnosis. In a decade the new term AKI has transformed our awareness of a serious condition that can happen anywhere in the NHS.1 2

AKI is defined by changes in serum creatinine from a previous baseline over a short period (28 μmol/L in 48 hours, or 50% in one week), and it is measured in three stages of severity depending on the magnitude of change. Even small changes in vulnerable patients can signal increased mortality.3 A national inquiry, Adding Insult to Injury, reminds us that late intervention can lead to preventable death, and we could all do better in our efforts to provide prompt and safe care.4 But our …