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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