1. “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

2. 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.

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

4. 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?

5. AKI – location and mortality

6. 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

7. 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

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

9. Who is at greatest risk?

10. ‘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

11. 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

12. 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

13. 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

14. Uptake of LIMS algorithm across England to date
60 of ~125 labs
now submitting data

15. Lets talk about ‘alerts’
Detect
Alert
Respond

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

17. 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
07/12/2018

18. 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

19. Contact Think Kidneys @UKRenalRegistry @thinkkidneys
How to find out more Karen Thomas Think Kidneys Programme Manager UK Renal Registry Teresa Wallace Think Kidneys Programme Coordinator
Richard Fluck National Clinical Director for Renal NHS England Joan Russell Head of Patient Safety Ron Cullen Director UK Renal Registry
kidneys
@UKRenalRegistry
@thinkkidneys
07/12/2018