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Of patients with recognized AKI, 16.5% developed CKD by 14 months. In comparison, 42% of patients with unrecognized AKI developed CKD by 14 months. Table?3. Unrecognized AKI AKI analyses by hospital The incidence of AKI was greater in RGH than NHH (7.8 versus 5.6%, P Quisinostat CKD (data not shown). Discussion AKI is a common clinical problem faced by a variety of specialists including general physicians, surgeons, intensivists and nephrologists. Several studies have demonstrated that AKI is associated with adverse patient outcomes including prolonged hospital stay, increased mortality and a heightened risk of developing CKD [3, 15�C19]. Many of these risks persist well after hospital discharge, demonstrating high personal and health-care costs. AKI risk is heightened in the elderly and in individuals with increased comorbid illnesses [8]. With an ageing population and a rising burden of chronic disease, AKI and ensuing CKD will continue to represent a significant problem faced by many specialties. It is becoming increasingly vital to implement health strategies within hospital front-line and specialist ankyrin services that are aimed at prevention and optimum management of this condition. This large study based in two DGHs in the UK identified an AKI incidence of 6.4%, of which approximately a third of patients had underlying CKD. Only 8.3% of AKI patients and 22.8% of patients with severe AKI were referred to nephrology. Thus, in the setting of a DGH with no dedicated in-patient nephrology service, AKI is almost entirely managed by general physicians and surgeons. The Selleckchem GSK3 inhibitor National Service Framework for Renal Services in the UK published in 2010 recommends that patients at risk of or with AKI should be promptly identified and given high-quality, clinically appropriate care in partnership with specialist renal teams [20]. Recently, KDIGO have published guidelines recommending that a nephrologist should follow-up survivors of AKI within 90 days of the AKI event [12]. In 2009, a national UK audit was performed evaluating recognition and management of AKI in patients who subsequently died [5]. This audit identified deficiencies in AKI management in ?50% of cases. In this study, only a third of AKI patients had renal imaging performed during their admission and only half of the patients with severe AKI had renal imaging performed. Furthermore, in 20.