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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.

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Readers' comments (9)

  • Probably the killer of patients on LCP, rather than initial disease/infection. Wake up lads and lasses-fluid intake is vital!

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  • Speaking as a retired nurse, I personally feel that there is not enough attention given to patients/residents over 65 in many care settings with regard to necessary hydration. The perfunctory cup of tea at breakfast, lunch and evening meal will never be enough to hydrate any patient or resident so fluid intake should be monitored much more carefully. Many elderly persons cannot help themslves to fluids even if they are available at the bedside.

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  • Gone is the early morning cup of tea. Must let the patients wake up when they want. We have even been told if they want their breakfast at 11am then that's ok. I know if I was to be admitted I would want my very large tea mug with me.

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  • In addition to closely monitoring the fluid intake and output of our patients I have been finding it very hard on 12 hour shifts to keep myself hydrated. Especially in settings that are chronically understaffed. Lets walk our talk

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  • Penny

    I agree, not only is it hard to ensure patients are adequately hydrated but also ourselves which is really quite important. there simply is not always time and of course we all know the consequences of taking in too much fluid when we are busy .......!

    On my last job I got caught in the ward kitchen by the home director at 9 am having a glass of water between patients! Coffee break wasn't until 9.30 am and we all had to take it together at the same time each day and not when our individuals body clocks were crying out for a little hydration!

    I would have thought well hydrated staff whose needs were also taken into consideration by their employers would be happier and better functioning and more alert beings and nurses! and this home director a psychologist. maybe I should have reminded him of Maslow. It was a new job where I was keen to do the right thing but I still hadn't learned the ropes!

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  • Here's a great solution to much of this problem - easy access to fluids - there is a GREAT product on the market that is being used in lots of hopsitals AND, more importantly, out in the community where it is preventing thousands of admissions by helping prevent UTI's and loads of other issues, like AKI, which are caused by not being able to reach, lift, or hold a drink without help. It is called THE HYDRANT and is available via NHS Supply Chain for hospitals on code UMB079. It simply enable people to drink without needing to call for help

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  • Anonymous | 28-Aug-2013 6:58 pm

    Brilliant. Well done. It is similar to the camel system used by sportsmen.

    Here is the link to the company and a couple of videos

    The Hydrant

    Mark Moran

    The Hydrant BBC News Aug 2012

    The Hydrant - preventing dehydration in a healthcare setting

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  • Is this a "professional" journal or a tabloid comic?

    Here is the actual report !

    Go read it !

    Then come back and tell us where in the report these doom-laden "death" statistics can be found.

    Time for the the NT to urgently improve the standard of reporting !

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  • Why has this topic been hidden ?

    Something do with the appalling standard of reporting maybe ?

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