It has recently been recognised that 5-7% of all admissions to hospital in the UK develop acute kidney injury (AKI) and that overall this is associated with an astonishing 20% risk of dying during that hospital admission. How much of this AKI, and the harm associated with it, is avoidable is as yet unknown, but evidence from the NCEPOD enquiry into deaths from AKI suggested that there is a lot of room for improvement in care. The measurement workstream of the Think Kidneys national programme, led by nephrologist Dr Nitin Kohle and GP Dr Dan Lasserson, aims to establish a register of all cases of AKI in England direct from hospital laboratories. So what will we be able to do with these data?
- Report variation in rates of/outcomes from AKI across the country (at the GP practice level, CCG level or hospital level) so that reasons for high and low rates of AKI can be explored and best practice identified.
- Describe differences in rates of/outcomes from AKI in different patient groups (the young/old, the multi-morbid, the socially deprived or minority ethnic groups) looking for evidence of inequalities and areas where efforts to reduce harm should be focussed.
- Evaluate the effectiveness of interventions to reduce rates of/harm from AKI. The UK Renal Registry’s ’master patient index‘ of all cases of AKI in primary and secondary care will provide a mechanism to routinely and cost-effectively capture rates of/outcomes from AKI as part of pragmatic trials of interventions in primary or secondary care. The Registry is already collaborating with researchers in Derby in a Health Foundation-funded stepped wedge cluster randomised trial that aims to reduce harm from AKI in 5-6 hospitals in England, experience that will test the quality and reliability of the new master patient index and develop the novel statistical skills to run future trials like this.
A formal plan of analyses possible with the new AKI data has recently been prepared and will soon be available here on the Think Kidneys website. If you have ideas as to how the Registry’s AKI master patient index could be used to safe lives or improve the quality of lives of patients with or at risk of AKI then please get in touch – you will be very welcome to join the measurement work stream!
Fergus Caskey
Fergus is a Consultant Nephrologist, an Honorary Senior Clinical Lecturer and Medical Director at the UK Renal Registry.
Having graduated from the University of Glasgow in 1993, Fergus went on to obtain a Masters in Public Health and Health Services Research and then a further Masters in the Cost-effectiveness of Dialysis in Europe from the University of Aberdeen. He has a special interest in health services research.
Fergus became a Consultant Nephrologist in Bristol in 2005 and was appointed Medical Director of the UK Renal Registry in 2013. His research interests include the epidemiology of chronic kidney disease (CKD) and end stage renal disease (ESRD) particularly around equity, the application of mixed methods research to understand the reasons behind observed differences, and the measurement of patient reported outcomes.