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This article has been double-blind peer reviewedIn this article…The burden and cost of acute kidney injuryThe benefits of involving frontline staff in developing commissioning leversAn example of a nurse-led commissioning projectAwareness of the harm caused by acute kidney injury (AKI) has increased in recent years, especially since the launch of the national Think Kidneys programme. At the end of 2013, Southern Derbyshire Clinical Commissioning Group created a working group tasked with creating a new AKI Commissioning for Quality and Innovation framework, which was launched in April 2014. As a result, crude mortality rates from AKI in Southern Derbyshire have decreased from 25.3% to 23.0%. This article reports on this nurse-led development of pathways of care, and commissioning levers and incentives, aimed at improving awareness, detection, prevention and treatment of AKI.