NICE issues warning over 'needless' hospital kidney deaths
Thousands of hospital patients are dying needlessly every year from kidney problems that could be treated, according to new NHS guidance.
Between 12,000 and 42,000 deaths could be prevented every year if patients received the best possible care.
Around 100,000 cases of acute kidney injury (AKI) - previously called acute renal failure - could also be stopped across England with simple checks such as ensuring patients are hydrated and their medicines are reviewed.
A new guideline from the National Institute for Health and Care Excellence (NICE) says AKI costs the NHS between £434m and £620m a year - more than it spends on breast, lung and skin cancer combined.
AKI refers to a loss of kidney function and can develop very quickly. It can occur in people who are already ill with conditions such as heart failure or diabetes, and those admitted to hospital with infections.
AKI can also develop after major surgery, such as some kinds of heart surgery, because the kidneys can be deprived of normal blood flow during the procedure.
If the condition is not picked up quickly it can lead to the kidneys shutting down, which can cause severe illness and death.
Between 262,000 and one million people admitted to hospital as an emergency will have AKI, of which just under a quarter will die.
Of these, between 12,000 and 42,000 deaths could be prevented if patients received good treatment, according to NICE.
A 2009 report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found only half of all patients with AKI had received good care, dropping to a third of those who developed it while in hospital.
A third of patients suffered due to inadequate investigations, including health staff not carrying out “simple” and “basic” checks.
Staff were also found to be “poor” at recognising symptoms and did not always refer patients to kidney specialists in time, while drug prescribing errors contributed to some deaths.
Dr Mark Thomas, chair of the new guideline development group and nephrologist at the Heart of England Foundation Trust, said: “AKI has been something of a Cinderella condition in the past both within healthcare and in the public perception, yet it kills more people than any of the common cancers.
“In the past, the care for this condition has not always been uniformly good, partly because the patients have tended to present to a range of non-specialists who may have been unfamiliar with the best prevention and treatment of the condition.”
He said the NHS had made “continuing improvements” since the NCEPOD report, which itself had prompted Nice to develop new guidelines.
“It’s now really over to the wider NHS to implement the guidance, which we believe can save both lives and money,” he said.
The new guideline says NHS staff should measure serum creatinine levels - a marker of kidney function - in those with existing conditions such as heart failure, liver disease, diabetes, a history of kidney problems or blood poisoning.
Patients taking common drugs such as ibuprofen, ARBs or ACE inhibitors for high blood pressure and other conditions, or diuretics, should also be monitored closely as these can have a negative impact on kidneys.
Other basic checks include measuring urine output and ensuring a patient is not dehydrated, the guideline said.
The guideline aims to ensure staff working in all parts of the NHS consider a diagnosis of AKI, not just those working in renal units.
Treatment can include treating the condition leading to AKI, such as dehydration or infection. Dialysis is needed by fewer than 10% of patients.
Professor Mark Baker, director of the centre for clinical practice at NICE, said: “Acute kidney injury is a huge problem for the NHS.
“This new NICE guideline aims to raise awareness among healthcare professionals to recognise and treat the condition early and focuses on prevention, recognition, treatment and timely access to specialist services for all.”
Dr Thomas added: “Many hospitals and healthcare professionals have been doing an excellent job in watching out for acute kidney injury in their patients, but unfortunately this good practice is not seen everywhere.
“The NICE recommendations give the NHS clear advice to reduce the number of avoidable deaths through acute kidney injury.
“Trusts that already perform to an excellent standard are encouraged to share their good practice and those that have not been performing so well are encouraged to ensure that AKI is taken seriously and their staff are well trained in the prevention and detection of the condition.”
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “This is important and timely guidance… which should help doctors and nurses to spot those patients who are at risk and be confident in monitoring and treating them.
“Specialist nurses are already making a considerable difference in this field and their expertise has been crucial to this guidance,” he added.
“This is an area of medicine where many lives could be saved if the level of understanding is the same among staff in all settings, and the NHS as a whole should act on this guidance as a matter of urgency.”
Fiona Loud, director of the Kidney Alliance, said: “Acute kidney injury is something that happens really quickly. Within a few hours your condition can become life-threatening, and it is completely avoidable.
“When something goes wrong in the body, the kidneys often suffer the consequences.
“Patients also play a role in the prevention and detection of AKI. Make sure you drink plenty of water and are regularly going to the toilet are ways to avoid the condition.”
More than half of people who develop AKI are over the age of 65.
Are you able to Speak out Safely?
Sign our petition to put pressure on your trust to support an open and transparent NHS
Online training units, written and reviewed by experts. Earn two hours' CPD and a personalised certificate for your portfolio.
Subscribers get FREE unlimited access to all our online learning units and non-subscribers can access each learning unit for £10 + VAT.