EARLY detection and treatment of acute kidney injury (AKI) should be a key priority among GPs and other primary care professionals, according to a new guideline published by NICE.
Greater awareness of how AKI can be prevented has the potential to save thousands of lives and many millions of pounds in care costs to the NHS, say the guideline developers.
Acute kidney injury is seen in 13–18 per cent of all people admitted to hospital in the UK, with older adults being particularly affected. Inpatient mortality of AKI is estimated to be 25–30 per cent or more and conservative estimates suggest that currently between £434million and £620million is spent on treating the condition, more than the NHS spends on breast cancer, or lung cancer and skin cancer combined. In view of its frequency and mortality rate, prevention or amelioration of just 20 per cent of AKI cases would prevent a large number of deaths and substantially reduce complications and their associated costs.
A 2009 enquiry into the deaths of a large group of adult patients with acute kidney injury found systemic deficiencies in the care of patients who died from AKI, with only 50 per cent described as receiving 'good' care. Deficiencies in the care of patients who died of AKI included failures in prevention, recognition, therapy and timely access to specialist services.
The new NICE guideline places emphasis on early detection of AKI before the condition becomes critical. Healthcare professionals should be monitoring their patient's kidney function including checking hydration levels and how regularly they are passing urine. Among the key priorities for implementation are identifying AKI in patients with acute illness by measuring serum creatinine and comparing with baseline, aassessing risk factors in adults having iodinated contrast agents and in patients having surgery, as well as ongoing assessment of the condition of patients in hospital, with early referral to nephrology in patients with signs of suspected AKI.
Dr Mark Thomas, Consultant Physician and Nephrologist at Heart of England NHS Foundation Trust and Chair of the Guideline Development Group for the guideline, says: "Many hospitals and healthcare professionals have been doing an excellent job in watching out for acute kidney injury in their patients, but unfortunately this good practice is not seen everywhere.
"The NICE recommendations give the NHS clear advice to reduce the number of avoidable deaths through acute kidney injury. Trusts that already perform to an excellent standard are encouraged to share their good practice and those that have not been performing so well are encouraged to ensure that AKI is taken seriously and their staff are well trained in the prevention and detection of the condition. Not only can we save lives with this guideline but the money we save could be put back into general NHS care."