Think Kidneys Chair, Dr Richard Fluck gave an AKI presentation at a meeting in Manchester on 11th January 2017

1. Think(ing) Kidneys
Raising the profile of AKI in
England
Dr Richard Fluck
richard.fluck@nhs.net,
Chair, Think Kidneys

2. 13/01/2017 | 2
An ‘intermediate’ health state
Associated with other serious illness
Important marker of illness severity
“Force multiplier” for poor outcomes
Potential to improve care
Reduce avoidable harm - death and
morbidity
Reduce cost
Acute Kidney Injury National Programme| Richard Fluck

3. Acute Kidney Injury National Programme| Richard Fluck | 3
‘Think Kidneys’ AKI Programme
Who is at risk?
When do people sustain AKI?
How should patients with AKI be
managed?
What do people need to know?
13/01/2017

4. KDIGO Clinical Practice Guideline for Acute Kidney Injury
Kidney International Supplement 2012; 2(1): 1-138
How is AKI defined?
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5. National Algorithm
Based in LIMS
Compares serial creatinine measures
It provides a warning test score to be
used in the context of clinical
judgement
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Improving diagnosis: using changes in serum creatinine
Laboratory definition and standardisation

7. | 8
Detect Alert
Lets talk about ‘alerts’
Respond
Acute Kidney Injury National Programme| Richard Fluck 13/01/2017
AKI Warning stage

8. Developing and disseminating resources
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10. Key points
Few drugs are ‘nephrotoxic’ – avoid use
of word
Most drugs are ‘situational’ in cases of
AKI
1. Causative
2. Adjuncts
3. Altered side effect profile
Role in reducing risk of AKI
Sick day guidance position statement
http://bit.ly/22sGdbs
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Medicines management http://bit.ly/1TNSGTD

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The community and care homes http://bit.ly/1TJG00K

12. Public awareness campaign http://bit.ly/1OViw3K
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13. ‘AKI warning
stage’
Patient
management
system
Alert Response
Local systems
Message
Master
patient
index
Other data
systems
AKI
Registry
Regional
National Research
QI
System Measurement
19

14. 76 laboratories now reporting
861,497 AKI warning levels in 272,402
patients reported (July 2016)
99.5% NHS number completeness
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Measurement http://bit.ly/1TJG00K
0
10
20
30
40
50
60
70
80
90
Stage 1 Stage 2 Stage 3
Percentage
AKIstage
Adults
Paeds

15. Why? High readmission rates
Primary care knowledge
Future risk
Medicines management
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Commissioning: national CQUIN

16. CQUIN Elements: discharge summary items on AKI
Stage of AKI; (a key aspect of AKI diagnosis)
Evidence of medicines review having been undertaken (a key aspect of AKI treatment)
Type of blood tests required on discharge for monitoring (a key aspect of post discharge care)
Frequency of blood tests required on discharge for monitoring (a key aspect of post discharge care)
Data from > 29000 case notes in 2015/16
Figure 1: Proportion of completed key items assessed in AKI patients' discharge summaries by
region (Quarter 1 2015/16 to Quarter 4 2015/16, England)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Quarter 1 Quarter 2 Quarter 3 Quarter 4
%ofkeyitemsinthereviewAKIdischarge
summaries
2015/16
North of England
Midlands and East of
England
London
South of England
Average rate of each
quarter
Figure 2: Proportion of providers above and below 50% completion rate of key items included
in AKI patients' discharge summaries (Quarter 1 2015/16 to Quarter 4 2015/16, England)
0%
20%
40%
60%
80%
100%
120%
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Percentageofkeyitemsinthe
reviewAKIdischargesummaries
2015/16
Below 50% 50-70% 70-80% 80-90% 90% and above

17. The brand and legacy
Data
Tools
Exemplars
Leadership
System Links
NHS Improvement
NHS England
NICE
Sustainability
UK Renal Registry and funding
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Going forward – sustainability and programme future

18. www.thinkkidneys.nhs.uk A summary
Think Kidneys
Has delivered system
levers
Providing a framework
for action
Raised the profile
It is supportive of other
change agents
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19. Karen Thomas
Think Kidneys Programme Manager
UK Renal Registry
Karen.Thomas@renalregistry.nhs.uk
Annie Taylor
Communications Consultant to the
Acute Kidney Injury National
Programme
anniemtaylor331@gmail.com
The UK Renal Registry team,
chairs, co-chairs and teams of
all the workstreams in ‘Think
Kidneys’
Joan Russell
Head of Patient Safety
NHS England
joan.russell@nhs.net
Ron Cullen
Director
UK Renal Registry
Ron.Cullen@renalregistry.nhs.uk
www.linkedin.com/company/think-
kidneys
www.twitter.com/ThinkKidneys
www.facebook.com/thinkkidneys
www.youtube.com/user/thinkkidneys
www.slideshare.net/ThinkKidneys
www.thinkkidneys.nhs.uk
Acknowledgements
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