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'Avoidable' acute kidney injury may be killing thousands

Tens of thousands of patients may be dying unnecessarily each year in English hospitals from acute kidney injury (AKI) resulting from poor care, a study has claimed.

Researchers said ‘at least a thousand patients a month’ are dying in hospital from these ‘avoidable’ cases of AKI, while annual numbers could be as high as 40,000.

The research, commissioned by NHS Quality Improvement and published in the journal Nephrology Dialysis Transplantation, found AKI was recorded in 2.43% of hospital admissions during 2010-11, while laboratory data collected by one trust in Kent suggested the true prevalence may be five times as high, at 14.15%.

Based on these data and related mortality rates, the team estimated that AKI could be associated with between 15,000 and 40,000 excess deaths each year.

The researchers called for closer monitoring of patients in hospital for dehydration and the need to change medications. They estimated preventing even a fifth of these AKI cases could save the NHS in the regions of £200 million a year – or 0.2% of the NHS budget in England.

Co-author Professor Donal O’Donoghue, from Salford Royal NHS Foundation Trust, said: ‘We know that at least a thousand people a month are dying in hospital from acute kidney injury due to poor care. These deaths are avoidable. This is completely unacceptable and we can’t allow it to continue. Good basic care would save these lives and save millions of pounds for the NHS.

‘Doctors and nurses need to make elementary checks to prevent AKI. In general, people who are having surgery shouldn’t be asked to go without water for longer than two hours. Sometimes that is unavoidable but then medical staff need to check their patients are not becoming dehydrated. They also need to be aware that some common medications increase the risk of AKI.’

In a related study, published in November last year, researchers at the University of Cambridge said that a rise in prescriptions for ACE inhibitors and angiotensin receptor blockers (ARBs) may have accounted for around 15% of the rise in AKI hospitalisations over the period 2007/08 to 2010/11 – or one in seven of the extra AKI admissions recorded over this time.

Nephrol Dial Transplant 2014; available online 21 April

Readers' comments (2)

  • Vinci Ho

    Combination of loop diuretics and ACE inhibitors is typically a potent and lethal one. Monitoring U&E creatinine /eGFR is essential before and after any change in dosages.
    Another situation is sepsis (from an infective source)with septic shock .

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  • Blame QoF leading to over medicalisation of the elderly.

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