Earlier this year I opened the newspapers to find headlines about people dying in NHS hospitals due to thirst. These were stories about acute kidney injury and there is, it seems considerable ignorance in the media, public and professional groups about this very important safety issue.
We have two kidneys, sitting in our abdomen at the back. Every minute of every day, the kidneys clean our blood through a filtering system producing urine. The kidneys regulate the amount of fluid in our body. The kidneys excrete the toxins our body builds up as part of our metabolism. The kidneys look after our blood and our bones. For people taking drugs it is very common that the drugs are got rid of in the urine.
So what happens if the kidneys go wrong?
The first thing to say is that someone might not notice at the early stages. There is no pain and there are no symptoms. Acute kidney injury comes on quickly – hours or days – and during those early stages blood tests are the best way to pick up a problem.
So what causes acute kidney injury?
There are three ways in which the kidney function may be affected. Reduce the blood supply, block the urine production and rarely, problems directly within the kidney itself. Dehydration may affect kidney function but rarely as the only cause. The commonest associations with acute kidney injury are serious infections (pneumonia, blood poisoning), heart problems and blockages of the urinary tract (for example prostate problems). In many cases, the drugs that someone has been taking to deal with another medical issue can then also add to the problem and affect the kidneys.
So how common is this?
We only have estimates of how common the problem is. It seems to be getting more common and it is a global problem, probably as people have more complex medical needs. It is estimated that between one in ten and one in five of emergency admissions have acute kidney injury as well as the underlying medical problem. About two thirds of those start in the community and a third arise after someone is admitted. The risk of death is high but largely related to the underlying medical emergency.
So what should be done?
NHS England has brought together a group of patients and professionals to improve the care of people who get acute kidney injury. We need to help the public, patients and professionals understand the issue and we need to support the NHS in measuring the impact of acute kidney. We need to identify people who are at risk, monitor them appropriately, diagnose the problem early and provide reliable and consistent treatment to everyone.
As a first step the Think Kidneys programme is providing the leadership to introduce a national system of measurement across the NHS in England. This will improve the early diagnosis, benefiting patients, carers and the teams that help care for them, supporting better outcomes. It will also allow NHS England and other organisations to count how much acute kidney injury is occurring and support the drive to reduce the avoidable harm acute kidney injury inflicts on people, their families and on health care. In doing so, the NHS will be the first national health system to have tackled this global problem.
Acute kidney injury is common and harmful, but it can be dealt with better. Not all episodes can be prevented but the NHS has the potential to be the safest health care system in the world and this work is a major part of it, reducing avoidable harm.
The mantra is simple – measure, educate and manage better.
This is shortened version of a full blog on NHS England’s website. To view Richard’s blog in full, go here.
Richard Fluck
Richard is currently the Chair of Think Kidneys AKI Board and was NHS England’s National Clinical Director (Renal) until March 2016. He continues as Clinical Co-Chair for Specialised Internal Medicine and Consultant Nephrologist at Derby Hospitals NHS Foundation Trust.
Richard trained at Trinity Hall, Cambridge and the London Hospital Medical College, qualifying in 1985. His early training was in the East London area before he moved into research at St Bartholomew’s Hospital. Richard was appointed a British Heart Foundation Fellow to explore the link between cardiovascular disease, calcium signalling and abnormalities of calcium metabolism in chronic kidney disease. He returned to the Royal London Hospital as lecturer and honorary senior registrar in nephrology, before being appointed as a single handed nephrologist at Derby in 1996. In 2013 Richard was appointed National Clinical Director for Renal and has also chaired the Kidney Alliance as well as being President of the British Renal Society. Richard’s special interests are in chronic kidney disease, acute kidney injury, home dialysis therapies, reducing infection in dialysis patients and vascular access.
When he is not at work he looks at his running shoes or twiddles on his guitar.