Thousands die with treatable kidney problems

“Tens of thousands of hospital patients may be dying needlessly each year because doctors and nurses are failing to diagnose a treatable kidney problem.”

Between 12,000 and 42,000 lives could be saved annually if hospital staff were more alert to the warning signs of acute kidney injury (AKI), according to the healthcare regulator.

The condition, formerly known as acute renal failure, has been familiar to kidney specialists for decades and is completely preventable, but it is still going undiagnosed by nurses and GPs.

Up to 100,000 cases of AKI could be prevented each year by simple steps such as ensuring patients stay hydrated and reviving their medication, the National Institute for Health and Care Excellence (Nice) said.

AKI is thought to affect one in every five or six patients who are admitted to hospital as an emergency, and is most common in those over the age of 65.

Patients experience a loss of kidney function, and if left untreated the condition can result in the organs shutting down leading permanent damage or the patient’s death.

It usually arises in people with chronic conditions such as as heart failure or diabetes, or in those admitted to hospital with infections.

In a new set of guidelines aimed at raising awareness of AKI among medical staff, patients and families, Nice estimated the condition costs the NHS between £434 million and £620 million a year – more than lung cancer and skin cancer combined.

Experts estimate that between 250,000 and a million emergency admissions to hospitals each year are complicated by AKI, and about a quarter of patients will die with the condition.

But about one in five cases is thought to be avoidable, suggesting that between 12,000 and 42,000 deaths could be prevented if patients were swiftly diagnosed and treated, Nice said.

In a damning 2009 report, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that only half of all AKI patients had been given a good level of care.

Dr Mark Thomas, chair of the new guideline development group, said: “AKI has been something of a Cinderella condition in the past both within healthcare and in the public perception, yet it kills more people than any of the common cancers.

“In the past, the care for this condition has not always been uniformly good, partly because the patients have tended to present to a range of non-specialists who may have been unfamiliar with the best prevention and treatment of the condition.”

AKI usually develops before patients enter hospital and is often down to problems like dehydration, or an adverse reaction from seriously ill patients to over-the-counter medicines such as ibuprofen, as a result of their condition.

Once in hospital, it can easily be diagnosed by a simple blood test or urine measurement, both of which are standard practice, but clinical staff are not always sure what warning signs to look for, the regulator said.

After being diagnosed, the condition can often be treated by addressing the underlying problem, for example by ensuring the patient stays hydrated or by switching their medication, with only 10 per cent of patients requiring dialysis.

Professor Mark Baker, director of the centre for clinical practice at Nice, said: acute kidney injury is a “huge problem” for the NHS, but added that the situation has begun to improve in since 2009.

Dr Richard Fluck, NHS England’s national clinical director for kidney care, added: “This is still a relatively new area and we are trying to understand what are the best things to do.

“(A decade ago), people didn’t realise that even mild degrees of AKI would make your outcomes worse if you had bad pneumonia or a bad infection.”