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Acute kidney injury (AKI) in England in 2018

I am delighted to write the foreword for the first national acute kidney injury (AKI) report for England, which reflects the hard work of a large number of people over the last seven years. AKI is common amongst patients, especially those admitted to hospitals as an emergency, and their outcomes, particularly in those with the two more severe levels of AKI are sobering, with one-in-four people dying within 30 days. Given the high number of patients involved, the complexity of care required and the protracted length of hospital stays, the cost to the NHS is substantial. Recent estimates put it at between £434 million and £620 million per year,1 more than the costs associated with breast, lung and skin cancers combined.

The publication of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report, ‘Acute Kidney Injury: Adding Insult to Injury’2 sparked the imperative to improve detection and care for people with AKI. Clinical experts reviewing cases of AKI in hospital where the patient died, concluded that AKI could have been prevented 15% of the time and that only 50% of patients received a standard of care that was considered ‘good’. Using clinical coding in hospital notes, it even proved difficult to accurately identify people who had AKI, with only 65% of the cases reviewed fulfilling the criteria.

I acknowledge the significant contributions and the hard work in this area under the umbrella of ‘Think Kidneys’ (thinkkidneys.nhs.uk) and all of its constituent workstreams. The leaders and members of the Think Kidneys programme are acknowledged at the end of this report, including the last National Clinical Director for Renal Disease for NHS England (NHSE), Dr Richard Fluck. Critically, Think Kidneys drove the development of the NHSE-funded AKI warning test score, now mandated by the NHSE patient safety directorate.

The data collection for the AKI warning test scores has always been with the UK Renal Registry (UKRR). This report is the product of the hard work of the laboratories that supply data and the UKRR that collects and analyses the data, as well as the continuing contribution from the wider renal community in their interpretation and impact. Initially, incomplete population coverage limited the scope to publish accurate comparative data on
AKI, but improved coverage over the last couple of years has now made this possible.

This report describes the current position of AKI in England and provides a unique platform to guide improved service planning and delivery, leading to major patient and health economic benefits. There is still a lot of work to do to improve the care of people with AKI across the whole of UK healthcare to identify those at risk of AKI (to avoid it), those with early AKI (to limit the damage) and those with established AKI to give them the greatest chances of recovery. The Renal Association, including the UKRR, working with the wider health community, look forward to facilitating the major opportunities created by this important work.

Dr Graham Lipkin, president of the Renal Association