Nutrition and hydration week 14 – 20 March 2016
One Easter weekend I opened a newspaper to be greeted with headlines about thousands of people dying from dehydration in NHS hospitals every year. The article was based on a recent publication analysing the role that acute kidney injury had in driving premature mortality in people who were acutely unwell. What is acute kidney injury or AKI as we abbreviate it? The textbooks tell us it is a rapid and reversible decline of kidney function – the ability of the body to regulate salt and water balance, excrete toxins and handle many drugs.
Whilst as you might expect the headline was an example of Fleet Street hyperbole, it hid a truism. Hydration and the kidneys are intimately linked. Dehydration, particularly in the context of complex medication regimes or other illness, can result in a serious decline in kidney function. That decline can be detrimental to an individual – illness may be prolonged, recovery delayed or the risk of death elevated. The numbers are staggering – 500000 cases of acute kidney per year, over 100000 deaths associated with acute kidney injury and of those 40000 are excess deaths. The cost is high to people but the cost to the system is also huge – it is estimated that about £500 million is expended on dealing with this issue. So what is being done?
Think Kidneys (www.thinkkidneys.nhs.uk) is a national programme of work between NHS England and the UK Renal Registry. It has been working for the last 2 years to improve the care of people with AKI, both on an individual level and across the system. It has worked in secondary and primary care, across specialities and in the community. It has explored education for the public, for patients and carers and for professionals. It has provided guidance to understand risk, improve diagnosis and ensure reliable treatment. It has established a system to measure the burden across the system and support the systems of care we take for granted. But let us return to hydration.
One of the most exciting things for me working with this programme has been the opportunity to talk to a wide range of committed professionals about AKI. One day that still sticks in my mind was the day we worked with a number of care homes. The message of AKI resonated with everyone in the room but the eye opener for me was the way the people in the room took the information and shaped it to deal with a central need within their own expertise. It was a need to educate their staff about the central importance of kidney function and to highlight the importance of keeping their vulnerable clients adequately hydrated.
And that is the fundamental link. The kidneys need fluid to work adequately. Dehydration in those people on complex combinations of drugs can result in a life threatening situation. So everyone needs to aware of how their kidneys are doing – a window to how well hydrated we are in health and illness. So Think Kidneys, Keep Hydrated.
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.