Acute Kidney Injury

100,000 deaths are year are associated with acute kidney injury. (NCEPOD 2009)

Costs to the NHS estimated to be £1 billion per year. (Kerr et al 2014)

Acute kidney injury (AKI) is the sudden and recent reduction in kidney function resulting in a inability to maintain fluid, electrolyte and acid base balance.

AKI is a syndrome that usually occurs in the presence of other acute illness such as SEPSIS or HEART FAILURE.

AKI is a clinical syndrome that is common, harmful and often avoidable. It encompasses a spectrum of injury from minor changes in kidney function to acute failure requiring renal replacement therapy.

AKI often starts in the community when a vulnerable patient develops an inter-current illness such as diarrhoea, vomiting or infection which leads to dehydration.

The main risk factors for development of AKI are: Age over 65yrs Nephrotoxic drugs (particularly NSAIDs, ACE-I/ARBs, diuretics) Previous AKI Chronic kidney disease Heart failure Diabetes Liver Disease Severe diarrhoea.

Diagnosis of AKI is based on either the urine output or the creatinine level (or both) AND clinical assessment, history, presentation.

National Institute for Health and Care Excellence (NICE) guidance on acute kidney injury CG169

Focuses on improving the management of episodes of these acute illness including the use of ‘medicine sick day rules’ that recommend the temporary cessation of potentially nephrotoxic drugs

· Is the patient taking any other medications which could exacerbate AKI? Consider withholding them. · Is the patient prescribed any medications where the dose needs to be amended in renal impairment? · Amend medication doses appropriate to the patient’s degree of renal impairment.

Be aware of other drugs excreted by the kidneys such as Metformin, Opioids, Some antibiotics, Digoxin & Lithium

What Next? How can the Medicines Management team help?