Over 60 per cent of acute kidney injury starts in the community, with the remaining cases developing in hospital patients. It's therefore important for primary healthcare staff to be aware of the risk factors which could lead to AKI. The condition occurs rapidly and often in patients who already have other illnesses. The most common underlying risk factors include:

• Previous acute kidney injury
• Pre-existing chronic kidney disease
• Age €“ patients aged 65 years or over
• Congestive heart failure
• Peripheral vascular disease (a build-up of fatty deposits in the arteries, restricting the blood supply to leg muscles)
• Diabetes
• Liver disease.

If you do not have access to patient notes in community pharmacy, you may recognise patients with these conditions from the medicines they take. For example, those with chronic kidney disease may be taking alfacalcidol, sodium bicarbonate, high dose furosemide or phosphate binders such as calcium carbonate, sevelamer and lanthanum. Patients with liver disease may be taking vitamin B or thiamine supplements, or propanolol twice daily.

Acute kidney injury usually occurs in patients with these underlying risk factors, alongside other serious illnesses or triggers. These potential triggers include:

Infections or sepsis (where the body's immune system goes into overdrive, setting off a series of reactions including widespread inflammation and blood clotting)
Hypovolaemia (a decreased volume of circulating blood in the body)
Hypotension (low blood pressure €“ for example, after a serious heart attack)
Certain medicines, including prescribed and OTC medicines.

Causes

Around 80 per cent of acute kidney injury cases are caused by pre-renal issues, such as sepsis, infections, hypovolaemia and hypotension, which lead to a reduced blood flow to the kidneys and cause them to deteriorate. Ten per cent of cases are caused by post-renal issues such as kidney stones, which obstruct urine flow from the kidneys. A further 10 per cent are caused by intrinsic renal causes resulting from damage to the functional tissues of the kidney.

Up to 30 per cent of all deaths associated with acute kidney injury could be avoided. There are several preventative techniques that can be used to reduce the likelihood of at-risk patients developing the condition.