hpe live talk 10112016

Think(ing) KidneysReducing the impact of AKI in secondary careDr Richard Fluckrichard.fluck@nhs.net,Chair, Think Kidneys

01/05/2023

Objectives

1) What is acute kidney injury?2) Why is it important?3) How is it diagnosed?4) What treatment is required?5) What about recovery from illness?6) Specific issues around medicines management

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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

01/05/2023KDIGO Clinical Practice Guideline for Acute Kidney InjuryKidney International Supplement 2012; 2(1): 1-138

How is AKI defined?

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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?

Risk Detection

Treat Recover

Education

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Risk http://bit.ly/1TGGphDNon modifiable or fixed factors

AgeCo morbidities - CKD

Modifiable factorsDrugsExposure to new drugs and

contrastVolume

TriggersSepsisHypovolaemiaHypotension

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Risk scoring and equations

DrugsACEi/ARB, NSAIDS, diuretics or contrast

Total score Low < 5 High >= 5

If high risk

Daily U&EsReview medicinesAssess fluid status and balance

Derby Risk Score (unvalidated)AgeAge > 75ClinicalHypotensionSepsisHypovolaemiaComorbiditiesKnown CKDCCFAtherosclerotic vascular diseaseLiver Cirrhosis

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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

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AKI Warning stage

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Care bundles http://bit.ly/27Xxn9I

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Review of care bundles

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Nephron 2016;134:195-199

Adjusted survival curve stratified by timing of completion of the AKI-CB.

Nitin V. Kolhe et al. Nephrol. Dial. Transplant. 2016;31:1846-1854

© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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Key pointsFew drugs are ‘nephrotoxic’ – avoid use of word

Most drugs are ‘situational’ in cases of AKI

1. Causative - rare2. Adjuncts – renal perfusion - common3. 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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Year 1Discharge communicationCommunication of AKINeed for follow upMedication reconciliation

Why?High readmission ratesPrimary care knowledgeFuture riskMedicines management

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Commissioning: national CQUINKey points for Quarter 3 2015/16:AKI data collection

Overall, case notes from a sample of 7,784 covering 31,136 key criteria for AKI. This is an increase of 8% since Quarter 2 (28,869 items)A rate of 55% (17,113 items) were completed in the review of AKI discharge summaries. A 60% increase of compared to Quarter 2 (10,668 items)All the NHS regions (London, North of England, South of England, Midlands and East of England) achieved between 51%-63% completed items (an increase in from 25%-39% in Quarter 2).

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Patient information http://bit.ly/1qTXKM0

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Public awareness campaign http://bit.ly/1OViw3K

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www.thinkkidneys.nhs.uk A summary

Think Kidneys

Has delivered system leversProviding a framework for actionRaised the profileIt is supportive of other change agentsPharmacists have a key role:risk, treatment and recovery

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Karen ThomasThink Kidneys Programme ManagerUK Renal RegistryKaren.Thomas@renalregistry.nhs.uk

Annie TaylorCommunications Consultant to the Acute Kidney Injury National Programmeanniemtaylor331@gmail.com

The UK Renal Registry team, chairs, co-chairs and teams of all the workstreams in ‘Think Kidneys’

Joan RussellHead of Patient SafetyNHS Englandjoan.russell@nhs.net

Ron CullenDirectorUK Renal RegistryRon.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

Acknowledgements

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