Download Acute Kidney Injury Primary Care Top Tips - G-Care

Acute Kidney Injury
Primary Care Top Tips
Over 60% of Acute Kidney Injury (AKI) presentations start in the community and primary care is
in a great position to play a leading role in tackling this problem. Even mild AKI episodes are
associated with poor outcomes for our patients and AKI costs the NHS an estimated £500m each
year in England alone.
1 Think AKI in patients with acute illness
The following increases the risk of AKI:
 Known significant CKD (CKD stage 3b (now G3b) i.e. those with eGFR < 45 and/or
those with ACR >30)
 heart failure
 liver disease
 diabetes
 history of AKI
 neurological or cognitive impairment or disability, which may mean limited access
to fluids because of reliance on a carer
 deteriorating early warning scores
 sepsis
 age 65 years or over
 symptoms or history of urological obstruction, or conditions that may lead to
obstruction
 use of drugs with nephrotoxic potential(e.g. NSAID’s, ACEI,ARB and diuretics)
2 React appropriately to sepsis and dehydration in patients “at risk”
Sepsis, dehydration, hypovolaemia and hypotension are the main triggers for AKI
episodes. Consider lowering your threshold for conducting a clinical review and treating
septic episodes earlier in at risk patients
3 Conduct medication reviews for “at risk” patients
In patients recognised to be at risk of AKI a medication review should be carried out
regularly to try to modify this risk.
Ask yourself are there safer alternatives to medications known to increase AKI risk?
4 Respond to acute illness in patients with CKD
Acute illness and CKD together increase the risk of AKI. Think renal function (bloods and
urine dipstick) for patients with CKD who are unwell. Care of patients with a possible
diagnosis of AKI in hospital follows a ‘Care Bundle’ protocol – please see GHT renal
pages on website (link here). There is national and local work to see how prompt clinical
care of AKI patients in all settings can be delivered – we will keep you updated.
5 Give patients tailored advice
Consider including tailored “sick day guidance” to patients and/or carers as part of
admission avoidance plans. Such advice could include:
 Fluid balance at times of acute illness
 When to seek medical help
 Sick day guidance
 Avoid “Over The Counter” NSAID’s
Patient information leaflets relating to AKI and Sick day guidance can be found on G-Care or click
here…………..
You may wish to use the following codes to assist you in your clinical management:
Clinical Term
At risk of acute kidney injury
Provision of written information about acute kidney
injury
Read Code
V2 (Emis
,Vision,
Microtest)
14Om.
Read Code
Version 3
(SystmOne
Only)
Xabu1
8OAG.
Xabuj
Also Ensure your practice has a priority system in place to follow up renal blood test results for
patients at risk of AKI who are unwell. This should include a review of handover practices.
Further information can be found on the Think Kidneys website: www.thinkkidneys.nhs.uk
Acute Kidney Injury NICE clinical guideline 169: www.nice.org.uk/guidance/cg169