Tuesday, 3 February 2009

Yes we can ... tackle acute kidney injury as well as chronic kidney disease

Acute Kidney Injury (AKI) had been the poor relation in the first 5 years of the Renal NSF. I can't count the times I have said CKD is common, harmful and treatable over the last few years - well AKI which is a sudden acute deterioration in kidney function is also common, harmful and treatable. Globally AKI is lagging behind Chronic Kidney Disease (CKD) in the kidney world priorities list. It has been dogged, not only by a plethora of different terms and lack of an agreed definition but also by the varied settings in which it occurs. Primary care physicians, pharmacists, acute physicians, intensivists, many surgical disciplines and kidney care services all have a part to play in improving the quality of care and outcomes in AKI. The better people with CKD are informed about their condition, the more alert they will be to reducing their AKI risks.

The adoption of a standard definition and staging system based on the concept of injury, recovery and severity of kidney dysfunction is to AKI what the KDOQI classification was for CKD. Last year, the Renal Association and Critical Care Society produced a best practice guideline. That includes suggestions for audit measures including aspects of epidemiology, prevention, timing and prescription for renal replacement therapy.

This year will see the publication of the Scottish enquiry into AKI and the NCEPOD report for England will be launched at the Royal Society of Medicine on 11 June. Looking at hospital episodes statistics information for hospitals with and without kidney units it is clear that AKI is common and carries a very high mortality.

I think the time is therefore right to consider how we can improve the quality of care and outcome for AKI and have asked Paul Stevens (President of the British Renal Society) to chair a meeting of all the interested societies and stakeholders in mid-March and Andrew Lewington (Consultant Renal Physician, St James’ Hospital, Leeds) has helped design the programme. Paul and Andrew were both authors of the Renal Association Clinical Practice Guidelines. I hope that we will reach a consensus on the terminologies to be used, review that data we may already have and what we will need in the future, consider the guidance and educational needs required by the service and our trainees and form a multi-professional joint working group to advise on all aspects of AKI.