Quality statement 1: Raising awareness in people at risk

Quality statement

People who are at risk of acute kidney injury are made aware of the potential causes.

Rationale

Many people who develop acute kidney injury are not aware of the potential causes and how to prevent it. Acute kidney injury can be prevented by educating people about the risks and how to stop it from developing. Better education delivered in primary care settings, outpatient settings and on discharge from hospital will help to reduce the number of people developing acute kidney injury outside hospital and the number being admitted to hospital with the condition.

Quality measures

Structure

Evidence of local arrangements to ensure that people who are at risk of acute kidney injury are made aware of the potential causes.

Data source: Local data collection.

Process

Proportion of people who are at risk of acute kidney injury who are made aware of the potential causes.

Numerator – the number in the denominator who are made aware of the potential causes of acute kidney injury in a documented discussion with their healthcare professional.

Denominator – the number of people who are at risk of acute kidney injury.

Data source: Local data collection.

Outcome

Incidence of acute kidney injury.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (GPs and district general hospitals) ensure that systems are in place for people who are at risk of acute kidney injury to be made aware of the potential causes and steps for prevention in a discussion with their healthcare professional (that also involves their parents or carers, if appropriate).

Healthcare professionals ensure that they discuss the potential causes of acute kidney injury and steps for prevention with people who are at risk (and with their parents or carers, if appropriate).

Commissioners (clinical commissioning groups) ensure that they commission services in whichpeople who are at risk of acute kidney injury are made aware of the potential causes and steps for prevention in a discussion with their healthcare professional (that also involves their parents or carers, if appropriate).

What the quality statement means for patients, service users and carers

People who are at risk of acute kidney injury are told about the risk in a discussion with their healthcare professional, which also involves their parents or carers if appropriate. The discussion should cover possible causes of acute kidney injury (for example, dehydration caused by diarrhoea and vomiting, and certain drugs that can affect the kidney) and what they can do to avoid it.

Source guidance

Definitions of terms used in this quality statement

People at risk of acute kidney injury

People who are particularly at risk of developing acute kidney injury in the community, and should have the risk discussed with them, include those who have any of the following:

  • history of acute kidney injury (determined by the discharge summary from an inpatient episode, documenting the stage and cause of acute kidney injury)

  • chronic kidney disease with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2

  • neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer.

[Expert opinion and NICE guideline CG169, recommendation 1.6.4]

Potential causes of acute kidney injury

The potential causes of acute kidney injury include conditions leading to dehydration (for example, diarrhoea and vomiting) and drugs that have nephrotoxic potential (including over‑the‑counter NSAIDs [non‑steroidal anti‑inflammatory drugs]). Healthcare professionals should discuss these causes and how to avoid them with people who are at risk (and their parents or carers if appropriate). The discussion should include the importance of staying hydrated, should be had at least once and should be documented in the person's notes. [Adapted from NICE guideline CG169, recommendation 1.6.4 with expert opinion]

Equality and diversity considerations

Young age, neurological or cognitive impairment or disability may result in limited access to fluids and a risk of dehydration for some people because of their reliance on others to maintain adequate fluid intake. This may include frail older people, people with dementia in care homes and people with physical disabilities. Also, the risk of acute kidney injury might increase for people of Muslim faith during periods of fasting if they have other risk factors (for example, if they are taking diuretics).