Acute kidney injury (AKI) is a common complication that occurs in hospitalized patients and appears susceptible to a wide variability in practice. This may lead to suboptimal quality of care. The concept of a ‘care bundle' for AKI has been proposed to improve the reliability and quality of care. A bundle is designed to be a structured method of improving care processes and outcomes. It contains a small set of evidence-based practices intended for a defined population and care setting. The Institute for Healthcare Improvement has developed guidelines for the design of care bundles. Care bundles for critically ill patients focusing on mechanical ventilation, central venous catheters, and sepsis have been widely implemented with modest success in terms of compliance and impact on care processes and outcomes. A care bundle for AKI is highly desired, given the observed practice variation and indication of poor care for AKI patients; however, existing proposals are too comprehensive and have not been focused on a defined population at-risk, clinical context or setting. They have also not engaged local stakeholders in the process.

1.
Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al: Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med 2013;39:420-428.
2.
Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE: The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 2011;79:1361-1369.
3.
Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, et al: Cost and mortality associated with postoperative acute kidney injury. Ann Surg 2015;261:1207-1214.
4.
Kerr M, Bedford M, Matthews B, O'Donoghue D: The economic impact of acute kidney injury in England. Nephrol Dial Transplant 2014;29:1362-1368.
5.
Hsu RK, McCulloch CE, Ku E, Dudley RA, Hsu CY: Regional variation in the incidence of dialysis-requiring AKI in the United States. Clin J Am Soc Nephrol 2013;8:1476-1481.
6.
Aitken E, Carruthers C, Gall L, Kerr L, Geddes C, Kingsmore D: Acute kidney injury: outcomes and quality of care. QJM 2013;106:323-332.
7.
KDIGO AKI Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.
8.
Goldstein SL, Kirkendall E, Nguyen H, Schaffzin JK, Bucuvalas J, Bracke T, et al: Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics 2013;132:e756-e767.
9.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD): Adding insult to injury: a review of the care of patients who died in hospital with a primary diagnosis of acute kidney injury (acute renal failure), 2009. http://www.ncepod.org.uk/2009report1/Downloads/AKI_report.pdf (accessed March 27, 2015).
10.
Hoste EA, De Corte W: Implementing the kidney disease: improving global outcomes/acute kidney injury guidelines in ICU patients. Curr Opin Crit Care 2013;19:544-553.
11.
Resar R, Griffin FA, Haraden C, Nolan TW: Using Care Bundles to Improve Health Care Quality. IHI Innovation Series White Paper. Cambridge, Massachusetts, Institute for Healthcare Improvement, 2012. http://www.ihi.org/resources/Pages/IHIWhitePapers/UsingCareBundles.aspx (accessed March 27, 2015).
12.
Ferrer R, Artigas A, Levy MM, Blanco J, González-Díaz G, Garnacho-Montero J, et al: Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008;299:2294-2303.
13.
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725-2732.
14.
Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T: Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 2005;31:243-248.
15.
van Zanten AR, Brinkman S, Arbous MS, Abu-Hanna A, Levy MM, de Keizer NF, et al: Guideline bundles adherence and mortality in severe sepsis and septic shock. Crit Care Med 2014;42:1890-1898.
16.
Scales DC, Dainty K, Hales B, Pinto R, Fowler RA, Adhikari NK, et al: A multifaceted intervention for quality improvement in a network of intensive care units: a cluster randomized trial. JAMA 2011;305:363-372.
17.
National Institutes for Health and Care Excellence (NICE): Acute kidney injury: prevention, detection and management of acute kidney injury up to the point of renal replacement therapy: National Institutes for Health and Care Excellence (NICE), 2013. http://www.nice.org.uk/guidance/cg169 (accessed March 27, 2015).
18.
Tsui A, Rajani C, Doshi R, De Wolff J, Tennant R, Duncan N, et al: Improving recognition and management of acute kidney injury. Acute Med 2014;13:108-112.
19.
Kolhe NV, Staples D, Reilly T, Merrison D, McIntrye CW, Fluck RJ, et al: Impact of compliance with a care bundle on acute kidney injury outcomes: a prospective observational study. PLoS One 2015;10:e0132279.
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