“the national perspective” Medical Director of the UK Renal Registry Acute Kidney Injury “the national perspective” Dr Fergus Caskey Medical Director of the UK Renal Registry

What is acute kidney injury? Acute kidney injury (AKI) is a rapid deterioration of kidney function, resulting in the inability to maintain fluid, electrolyte and acid-base balance. It normally occurs in the context of other serious illness (e.g. sepsis) on a background of risk.

How is AKI defined? KDIGO Clinical Practice Guideline for Acute Kidney Injury Kidney International Supplement 2012; 2(1): 1-138

Who is most at risk? Two patients are admitted via accident and emergency on a Friday night. George, an 86 year old man has crushing chest pain and ECG changes consistent with a large heart attack. Julia, a slim 56 year old, with long standing diabetes, has not been feeling right - the GP did a blood test and her serum creatinine is 456 umol/L. Who should we most be worried about?

AKI – location and mortality

Why is it important? Associated with other serious illness “Force multiplier” for poor outcomes Potential to improve care Reduce avoidable harm - death and morbidity Reduce cost Important marker of illness

NCEPOD report published in 2009 Poor assessment of risk factors for AKI and acute illness Delays in recognising AKI Most patients with AKI are not cared for by nephrologists Most patients with AKI are not cared for by nephrologist ‘Good’ care in <50% cases

Who is at greatest risk? For George, his risk of death is 32.2% For Julia, her risk of death is 53.1%

Who is at greatest risk? www.thinkkidneys.nhs.uk

‘Think Kidneys’ AKI Programme Focused on: Who: who is at risk, vulnerable population, important triggers When: when do people sustain AKI, how is early diagnosis supported How: how should AKI be managed, prevention+treatment+recovery What: what do people need to know, public patients/carers, professionals

The vulnerable population Fixed factors Modifiable risk factors The elderly Drugs The frail NSAID – auto-regulation Existing comorbidities Diuretics – volume status Chronic kidney disease ACEi/ARB and other BP targeted medications – BP and auto-regulation Previous history of acute kidney injury Metformin – side effects enhanced

Reducing risk: Sick day guidance (a.k.a rules) Previous history of acute kidney injury Bristol CLAHRC undertaking formal evidence review Plan to use this to build consensus with other stakeholders e.g. British Hypertension Society, British Society for Heart Failure Interim position statement prepared for Think Kidneys website - bit.ly/TK-Sick-Day-Rules

National Algorithm By 9th March 2015 Focused on: Who: who is at risk, vulnerable population, important triggers When: when do people sustain AKI, how is early diagnosis supported How: how should AKI be managed, prevention+treatment+recovery What: what do people need to know, public patients/carers, professionals

Uptake of LIMS algorithm across England to date 60 of ~125 labs now submitting data www.thinkkidneys.nhs.uk/aki/aki-data/

Lets talk about ‘alerts’ Detect Alert Respond

Step 1: Form Think Kidneys Primary Care Working Group 07/12/2018

Coming soon! 4th April 2016 Guidance for Primary Care in responding to the e-Alerts Medicines Optimisation for Primary Care Primary Care Risk Matrix Patient information Infographic STOP at risk of AKI cards www.thinkkidneys.nhs.uk/resources/ 07/12/2018

Summary AKI is: Common Treatable 1 in 5 of all emergency admissions Education Early detection 2/3 starts in the community Better intervention Costly It increases the risk of death and harm It costs resources

Contact Think Kidneys @UKRenalRegistry @thinkkidneys How to find out more Karen Thomas Think Kidneys Programme Manager UK Renal Registry Karen.Thomas@renalregistry.nhs.uk Teresa Wallace Think Kidneys Programme Coordinator Teresajane.Wallace@renalregistry.nhs.uk Richard Fluck National Clinical Director for Renal NHS England Richard.fluck@nhs.net Joan Russell Head of Patient Safety Joan.russell@nhs.net Ron Cullen Director UK Renal Registry Ron.cullen@renalregistry.nhs.uk www.linkedin.com/company/think- kidneys www.twitter.com/ThinkKidneys www.facebook.com/thinkkidneys www.youtube.com/user/thinkkidneys www.slideshare.net/ThinkKidneys www.thinkkidneys.nhs.uk @UKRenalRegistry www.thinkkidneys.nhs.uk/resources/ @thinkkidneys 07/12/2018