An updated quality standard published today (23 March 2023) by NICE outlines improvements in care for people who have or are at risk of acute kidney injury.
Acute kidney injury is a sudden, potentially reversible, loss of kidney function associated with high mortality.
There are a number of causes of acute kidney injury including dehydration, serious infection or a blockage in the urinary tract. It can affect anyone, but it is more common in older people and people who are already unwell with other medical conditions.
Acute kidney injury is increasing, in part due to an aging population with 13 to 18 per cent of people admitted to hospital affected. 60 per cent of cases start in the community. As a result, treating acute kidney injury accounts for about 1 per cent of the NHS budget.
The quality standard sets out six priority areas, with three new statements that focus on delivering the best care for individuals and providing good value for money.
Professor Jonathan Benger, Chief Medical Officer at NICE said: “This quality standard sets out useful and usable statements to help prevent, detect and care for people who have or may be at risk of acute kidney injury.
“Acute kidney injury is a condition that affects a significant proportion of people admitted to hospital, and it is a particular concern among older people. People with this condition are more likely to have long-term health problems such as heart disease or diabetes. It is therefore important that the care they receive reduces their risk of mortality and serious ongoing health problems.”
Dr Nitin V Kohle, NHS England National Clinical Advisor for Acute Kidney Injury, said: “This quality standard complements the work that NHS England’s Renal Services Transformation Programme has been doing to improve renal care. Improving care for acute kidney injury is a high priority given the number of cases in hospital and the community.
“NHS England’s mandatory acute kidney injury algorithm is helping to improve detection of acute kidney injury based on acute kidney injury warning stage test results. The quality standard will help to improve the response to these warning stage test results in hospital and the community. It will also help to reduce hospital readmissions by improving follow-up after hospital discharge. It will require improved co-ordination across primary and secondary care.”
In this updated quality standard, the three new statements are:
- People with an acute kidney injury warning stage 2 test result have a clinical review within 6 hours if they are acutely ill or admitted to hospital, or within 24 hours if they are clinically stable.
- If the warning signs from the test results are worse, or stage 3, people should have a clinical review within 6 hours or, if they are acutely ill in the community, an immediate review to consider admission to hospital.
- People discharged from hospital after acute kidney injury have a clinical review within 3 months, or sooner if they are at higher risk of poor outcomes.
Three statements from the previous quality standard on acute kidney injury, published in 2014, have been updated.
The updated statements say:
- Children, young people and adults who are at risk of acute kidney injury are given advice on maintaining kidney health.
- Children, young people and adults admitted to hospital who are at risk of acute kidney injury have their serum creatinine level monitored.
- Children, young people and adults with acute kidney injury who meet the criteria for renal replacement therapy are referred immediately to a nephrologist or, if appropriate, a critical care specialist.
The standard provides measures and definitions to support healthcare providers and practitioners to deliver high quality care.
The updated quality standard was developed with the involvement of renal clinicians and people affected by acute kidney injury.