National Institute for Health and Clinical Excellence (NICE)
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Thousands of lives could be saved each year from acute kidney injury, says NICE
The NHS could save at least 12,000 lives from acute kidney injury (AKI) each year by following new guidance from NICE.
One in five patients who are emergency admissions to hospital will present with AKI, a condition that refers to the loss of kidney function over hours or days.
But despite the frequency of the condition, AKI is often considered to be a ‘Cinderella' condition with low levels of awareness and education among health professionals and the general public.
A report in 2009 from the National Confidential Enquiry into Patient Outcome and Death found that only half of patients with AKI had received 'good' care, with delays in diagnosis due to only a third receiving adequate investigations.
This latest guideline from NICE aims to build on improvements in NHS care for AKI patients that have been seen since the 2009 report and to standardise care across the NHS so that every patient receives the best practice and treatment.
The guideline emphasises the importance of early detection of AKI. If the condition is not picked up in time then it can lead to the kidneys becoming overwhelmed and they will shut down leading to irreversible injury or possibly death.
Around 20 per cent of emergency cases of AKI are preventable which would save around 12,000 lives each year in England.
Dr Mark Thomas, Consultant Physician and Nephrologist at the Heart of England NHS Foundation Trust and Chair of the group that developed the guideline, said: “AKI can be readily identified by measuring serum creatinine levels and urine output. These tests are currently done when patients present to hospital but the healthcare professionals should be monitoring the results closely for signs of AKI.
“Cases of AKI can be prevented by picking it up early and treating it. This involves stopping dehydration, treating any infections and treating the underlying cause of the AKI.
“There are a range of drugs that can upset the kidneys. So patients with AKI who are on drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and ACE-inhibitors will need to have their drug use monitored.”
Dialysis is only an option for less than 10 per cent of patients, added Dr Thomas.
Coral Hulse, Nurse Consultant at Mid-Cheshire Hospitals who was also involved in developing the guideline, said: “Nurses can play a key role in watching for signs and symptoms of kidney problems in their patients.
“Monitoring fluid intake and how much urine is passed is vital in the war against AKI as is monitoring the medication the patient takes and checking results as soon as they are available”
Professor Mark Baker, Director of the team at NICE responsible for the guideline, said: “AKI is a huge problem for the NHS. This new NICE guideline aims to raise awareness among healthcare professionals to recognise and treat the condition early and focuses on prevention, recognition, treatment and timely access to specialist services for all.”
Dr Richard Fluck, National Director for Kidney Care, said: “By taking a systematic approach to the assessment of risk, early detection, training and simple therapy, the NHS has the opportunity to improve the outlook for people who have AKI and to be at the forefront in tackling this international health concern.”
Professor Donal O'Donoghue, Former National Clinical Director for Kidney Care, said: “This important guideline from NICE highlights what can be done to identify and treat AKI - simple intervention can have profound effects but currently the NHS is missing the opportunity to improve outcome in those who develop AKI.
“AKI is silent but deadly. Alarmingly it complicates in the region of half a million admissions to hospital each year and yet 30 per cent is predictable and avoidable by getting the basics right.”
