Andy Lewington and Sarah Harding on behalf of the Risk Workstream
The Risk workstream of the Think Kidneys programme has devoted a lot of time into looking at how people “at risk” but who haven’t had Acute Kidney Injury (AKI) can be identified and cared for to minimise their risk of an event.
There are no specific treatments for the most common forms of AKI other than good medical care and treatment of the underlying cause which is most often sepsis and low blood pressure. Prevention of AKI is therefore essential. It has been estimated that as many as 30% of cases of AKI could be prevented. Economic evaluation of the cost of AKI to the NHS has demonstrated that there will be significant savings if we could improve our detection of patients at high risk of AKI and implement appropriate preventative measures.
Unfortunately there are currently no validated AKI risk calculators that are uniformly used across the NHS. There is therefore an immediate need to develop such tools. The Risk workstream has a number of ongoing projects looking at developing such risk calculators. Early indications are that patients at higher risk are those of older age and with chronic kidney disease. It may be argued that that is not particularly helpful information to a general practitioner in busy surgery! Undoubtedly further work needs to be done but there are a green shoots appearing most recently in the BMJ there was an AKI risk calculator for patients undergoing orthopaedic surgery. We will keep you posted.
Following a very productive meeting in London the Risk workstream has started to develop “at Risk of AKI” card that can act as a point of communication between patient and various health professions. The card would be offered to patients during a routine GP care planning event, like an annual review in primary care or following an episode of AKI in secondary care. To help deliver this advice the health profession should assist the patient/carer with the specific reason they are considered at higher risk of AKI and if indicated give specific advice. The card would then empower the patient to help other health professions “think kidneys” when they present with acute illness or need their medication changing.
Further projects include the development of an AKI risk matrix for primary and secondary care which identifies patients with inherent risks of AKI and how exposure to other insults such as sepsis or hypotension may further increase the risk of AKI. Such patients should have preventative measures instituted early and heightened surveillance. The group has proposed the adoption of the STOP AKI management acronym which has been recently published in the Royal College of Physicians AKI and Intravenous Fluids acute care toolkit. It promotes the implementation of a number of measures that include screening for sepsis, avoiding toxins, optimising blood pressure and preventing harm by identifying the underlying cause, treating complications, reviewing medication doses.
The Risk workstream will come together with the Intervention work stream in January 2016 to harmonise these important developments. Merry Christmas and a Happy New Year.
Andrew Lewington
Consultant Renal Physician/Honorary Clinical Associate Professor,
Director of Undergraduate Medical Education
Leeds Teaching Hospitals Trust
Andrew studied renal medicine in Leicester and at Washington University USA, where he investigated the molecular mechanisms underlying acute kidney injury.
Andrew provides a specialist renal opinion for critically ill patients on the intensive care units across Leeds. He was an expert adviser on the National Clinical Enquiry into Patient Outcomes and Death (NCEPOD) ‘Adding Insult to Injury’, acute kidney injury report in 2009. He was appointed to the Department of Health Acute Kidney Injury Delivery Board to address the recommendations proposed in the NCEPOD report.
In 2011 Andrew was appointed Chair of the NICE accredited Renal Association Clinical Practice Guidelines Committee. He was a member of the NICE AKI and IV Fluid Therapy Clinical Practice Guideline Committee and is currently on the NICE AKI and RRT Quality Standards Group. Andrew is Co-Chair of the UK Kidney Research Consortium AKI Study Group and his research is focused on biomarker discovery and development. He is a member of the ISN AKI committee and Co-Chair of the Education workstream of the ISN ‘0 by 25’ initiative. Andrew is Chief Investigator for the NIHR Kidney transplant biomarker study and Epidemiology of AKI in Critically Ill Patients on ICU. He is a co-applicant on a £1.2M grant from the NIHR for the Diagnostic Evaluation Cooperative to investigate the clinical and cost effectiveness of biomarkers in the NHS. Most recently he has secured NIHR funding to evaluate ways of preventing acute kidney injury in the community and HTA funding to analyse the economic impact of acute kidney injury on the ICU.
Chair of the NHS England AKI Risk workstream
Sarah Harding
Sarah loves life and to prove it, gets around a bit! A full time GP in Leeds, Sarah has undertaken her professional training in Southampton, Tauranga in New Zealand, Northumberland and Brisbane, Australia. A recent holiday to Nova Scotia has inspired her for more travel.
Sarah is Co-chair of the Risk workstream on the acute kidney injury national programme and has a special interest in diabetes, chronic kidney disease and acute kidney injury.