Kidney failure deaths must be prevented

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has uncovered systematic failings in the clinical care of patients suffering from acute kidney injury (AKI). The report Adding Insult to Injury stated that doctors are failing to carry out basic care plans, are unable to recognise acute illness, while organisational deficiencies are inhibiting investigation and management. The review, which looked at 564 deaths, found that 50% of patients did not receive good care. One of the report’s authors, Dr James Stewart, warned: “The very essentials of medical care are being omitted, and – unless attention is paid to the basics – patients will continue to die unnecessarily.”

Acute kidney injury

Acute kidney injury (otherwise known as acute renal failure) is both a prevalent and serious problem among hospitalised patients. Although no definitive studies have been undertaken in the UK, the prevalence among hospitalised patients in the US is 4.9%. AKI should be easily recognised by the onset of oliguria, anuria and/or deteriorating biochemistry. However, if unrecognised and allowed to deteriorate, AKI will result in uraemia, acidosis, hyperkalaemia and ultimately death. AKI is often silent until ill health or complications become apparent. Effective management depends on doctors formulating appropriate basic care plans and recognising when complications arise. They also need to be backed up by appropriate access to investigations and specialist support. NCEPOD concluded that all too often this was not available.