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Think(ing) KidneysRaising the profile of AKI in EnglandDr Richard [email protected],Chair, Think Kidneys
01/05/2023 | 2
An ‘intermediate’ health stateAssociated with other serious illness
Important marker of illness severity
“Force multiplier” for poor outcomes
Potential to improve care
Reduce avoidable harm - death and morbidity
Reduce cost
Acute Kidney Injury National Programme | Richard Fluck
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‘Think Kidneys’ AKI Programme
Who is at risk?
When do people sustain AKI?
How should patients with AKI be
managed?
What do people need to know?
01/05/2023KDIGO Clinical Practice Guideline for Acute Kidney InjuryKidney International Supplement 2012; 2(1): 1-138
How is AKI defined?
Acute Kidney Injury National Programme | Richard Fluck | 4
01/05/2023
National Algorithm
Based in LIMS
Compares serial creatinine measures
It provides a warning test score to be
used in the context of clinical
judgement
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Improving diagnosis: using changes in serum creatinine
Laboratory definition and standardisation
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Detect Alert
Lets talk about ‘alerts’
Respond
Acute Kidney Injury National Programme | Richard Fluck
AKI Warning stage
01/05/2023
Developing and disseminating resources
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Key pointsFew drugs are ‘nephrotoxic’ – avoid use of word
Most drugs are ‘situational’ in cases of AKI
1. Causative2. Adjuncts3. Altered side effect profile
Role in reducing risk of AKISick day guidance position
statementhttp://bit.ly/22sGdbs
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Medicines management http://bit.ly/1TNSGTD
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The community and care homes http://bit.ly/1TJG00K
01/05/2023
Public awareness campaign http://bit.ly/1OViw3K
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‘AKI warning stage’
Patient management
system
Alert Response
Local systems
MessageMaster patient index
Other data systems
AKI Registry
RegionalNational Research
QI
System Measurement
19
01/05/2023Acute Kidney Injury National Programme | Richard Fluck
76 laboratories now reporting
861,497 AKI warning levels in 272,402 patients reported (July 2016)
99.5% NHS number completeness
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Measurement http://bit.ly/1TJG00K
0
10
20
30
40
50
60
70
80
90
Stage 1 Stage 2 Stage 3
Perc
enta
ge
AKI stage
AdultsPaeds
01/05/2023
Why? High readmission ratesPrimary care knowledgeFuture riskMedicines management
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Commissioning: national CQUIN
CQUIN Elements: discharge summary items on AKIStage of AKI; (a key aspect of AKI diagnosis)Evidence of medicines review having been undertaken (a key aspect of AKI treatment) Type of blood tests required on discharge for monitoring (a key aspect of post discharge care)Frequency of blood tests required on discharge for monitoring (a key aspect of post discharge care)Data from > 29000 case notes in 2015/16
01/05/2023
The brand and legacyDataToolsExemplarsLeadership
System LinksNHS ImprovementNHS England
NICESustainability
UK Renal Registry and funding Acute Kidney Injury National Programme | Richard Fluck | 23
Going forward – sustainability and programme future
01/05/2023
www.thinkkidneys.nhs.uk A summary
Think Kidneys
Has delivered system leversProviding a framework for actionRaised the profileIt is supportive of other change agents
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01/05/2023
Karen ThomasThink Kidneys Programme ManagerUK Renal [email protected]
Annie TaylorCommunications Consultant to the Acute Kidney Injury National [email protected]
The UK Renal Registry team, chairs, co-chairs and teams of all the workstreams in ‘Think Kidneys’
Joan RussellHead of Patient SafetyNHS [email protected]
Ron CullenDirectorUK Renal [email protected]
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
Acknowledgements
Acute Kidney Injury National Programme | Richard Fluck | 25
