Research supports GIRFT recommendation to improve care for patients with acute kidney injury (AKI)

AKI hospital mortality study

A landmark paper paving the way for NHS care to be improved for patients with post-hospitalisation acute kidney injury (AKI) has been published by the UK Renal Registry (UKRR) in collaboration with the Getting It Right First Time (GIRFT) programme.

Centre variation in mortality following post-hospitalisation acute kidney injury: Analysis of a large national cohort has recently been published in Nephrology Dialysis Transplantation (NDT), an official journal of the European Renal Association.

AKI is a common syndrome affecting up to one in five hospitalised patients worldwide. Patients with AKI are vulnerable to serious complications, including renal failure requiring dialysis, prolonged hospitalisation, chronic kidney disease and death.

Care of patients with AKI has been an important patient safety concern in England following a 2009 National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report, in which care was deemed ‘good’ in only 30% of post-admission AKI cases.

The GIRFT national report for renal medicine, published in September 2021, outlined measures to improve the management of AKI patients, including a recommendation for the UKRR to report comorbidity and case-mix adjusted AKI incidence and mortality in all acute trusts and to publish the data in the Model Hospital and the UKRR annual report.

GIRFT and the UKRR have now worked together to develop a standardised mortality indicator for patients with post-hospitalisation AKI across NHS trusts in England, using routinely-collated national laboratory AKI alert data, linked to hospital episode statistics (HES) data.

Research for the NDT paper examined 250,504 AKI episodes in 106 NHS trusts and found the 30-day mortality rate was high, at 28.6%. The risk of mortality was higher for men, those of advancing age, patients admitted as an emergency admission, those admitted during winter months and those from more deprived areas. Despite adjustment for these factors, significant variation was noted in standardised mortality ratios across English trusts.

Patients who presented at a trust with a co-located specialist nephrology service and those of Asian or Black ethnicity had a lower mortality risk.

The paper is authored by a team of ten clinicians, including GIRFT renal leads Dr Will McKane and Dr Graham Lipkin. The research team was led by GIRFT renal clinical fellow Dr Javeria Peracha (UKRR and the department of nephrology at the Queen Elizabeth Hospital Birmingham) and Mr David Pitcher (UKRR).

Their work laid the foundation for the development of AKI data dashboards, which are now helping to facilitate routine monitoring of outcomes for patients with AKI across NHS trusts. Such dashboards will be an important patient safety indicator for hospitals and can be used as a tool for ongoing quality improvement in AKI patient care. The dashboards are now live on the UKRR website here:

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