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Better kidney care could save up to 42,000 lives a year, says Nice Better kidney care could save up to 42,000 lives a year, says Nice
(21 days later)
Up to 42,000 deaths from kidney problems could be prevented every year if patients received the best possible care, including giving them enough water and the right drugs, NHS guidance reveals.Up to 42,000 deaths from kidney problems could be prevented every year if patients received the best possible care, including giving them enough water and the right drugs, NHS guidance reveals.
About 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.About 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 report issued on Wednesday 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.A new guideline report issued on Wednesday 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 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.
It can also develop after major surgery, such as some kinds of heart surgery, because the kidneys can be deprived of normal blood flow.It can also develop after major surgery, such as some kinds of heart surgery, because the kidneys can be deprived of normal blood flow.
If the condition is not picked up quickly it can cause the kidneys to shut down, leading to severe illness and death.If the condition is not picked up quickly it can cause the kidneys to shut down, leading to severe illness and death.
Between 262,000 and 1 million people admitted to hospital as an emergency in a year will have AKI, of which just under a quarter will die.Between 262,000 and 1 million people admitted to hospital as an emergency in a year 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.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 inquiry into patient outcome and death 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 2009 report from the national confidential inquiry into patient outcome and death 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 because of inadequate investigations, including health staff not carrying out simple and basic checks.A third of patients suffered because of 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.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.
Fiona Loud, director of the Kidney Alliance, said: "AKI is something that happens really quickly. Within a few hours your condition can become life-threatening, and it is completely avoidable.Fiona Loud, director of the Kidney Alliance, said: "AKI 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."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.""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."
Dr Mark Thomas, chair of the new guideline development group and nephrologist at the Heart of England NHS 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.Dr Mark Thomas, chair of the new guideline development group and nephrologist at the Heart of England NHS 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.""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 2009 report, which itself had prompted Nice to develop new guidelines.He said the NHS had made continuing improvements since the 2009 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."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.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.
Other basic checks include measuring urine output and ensuring a patient is not dehydrated, the guideline said.Other basic checks include measuring urine output and ensuring a patient is not dehydrated, the guideline said.
Patients taking common drugs such as ibuprofen, ACE inhibitors for high blood pressure and other conditions, or diuretics, should also be monitored closely as these can affect the kidneys.Patients taking common drugs such as ibuprofen, ACE inhibitors for high blood pressure and other conditions, or diuretics, should also be monitored closely as these can affect the kidneys.
Professor Donal O'Donoghue, the government's national clinical director for kidney care from 2007 to earlier this year, has said 32 people die needlessly every day from AKI. In a Scrubbing Up column for the BBC website in June, he said AKI represented a "human tragedy".Professor Donal O'Donoghue, the government's national clinical director for kidney care from 2007 to earlier this year, has said 32 people die needlessly every day from AKI. In a Scrubbing Up column for the BBC website in June, he said AKI represented a "human tragedy".
About one third of cases could be prevented through the "provision of basic clinical care," he said.About one third of cases could be prevented through the "provision of basic clinical care," he said.
"That's as simple as making sure that patients are hydrated, medication is reviewed, and infections are treated promptly and reliably."That's as simple as making sure that patients are hydrated, medication is reviewed, and infections are treated promptly and reliably.
"To help put these statistics in perspective, the numbers of preventable deaths from AKI is exactly 10 times the number of people that died in Mid Staffs, and works out at 32 people each day in the NHS.""To help put these statistics in perspective, the numbers of preventable deaths from AKI is exactly 10 times the number of people that died in Mid Staffs, and works out at 32 people each day in the NHS."
He said AKI "is clearly one of the major patient safety issues for the NHS. It affects the vulnerable and leads to thousands of unnecessary deaths because of failings in care."He said AKI "is clearly one of the major patient safety issues for the NHS. It affects the vulnerable and leads to thousands of unnecessary deaths because of failings in care."
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