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NICE guideline [NG148] This guideline covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury. 
The guideline states:
  • Acute kidney injury, previously known as acute renal failure, encompasses a wide spectrum of injury to the kidneys, not just kidney failure. 
  • Acute kidney injury is seen in 13% to 18% of all people admitted to hospital, with older adults being particularly affected. These people are usually under the care of healthcare professionals practising in specialties other than nephrology, who may not always be familiar with the optimum care of people with acute kidney injury.
  • There have been concerns that suboptimal care may contribute to the development of acute kidney injury. In 2009, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reported the results of an enquiry into the deaths of a large group of adults with acute kidney injury. This described systemic deficiencies in the care of people who died from acute kidney injury: only 50% of these had received 'good' care. Other deficiencies in the care of people who died of acute kidney injury included failures in acute kidney injury prevention, recognition, therapy and timely access to specialist services. 
  • The NICE guideline emphasises early intervention and stresses the importance of risk assessment and prevention, early recognition and treatment. It is primarily aimed at the non-specialist clinician, who will care for most people with acute kidney injury in a variety of settings.
  • NICE recommendations aim to address known and unacceptable variations in recognition, assessment, initial treatment and referral for renal replacement therapy. 
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The Christie Hospital have an AKI specialist nursing team who: 
  •  review patients primarily with AKI stage 2&3 in the inpatient and outpatient settings and work off a live alert list throughout the day. 
  •  assist with ensuring the relevant patient teams are aware of any AKI alerts particularly if the patient is in outpatients. 
  • have set up an electronic AKI bundle on the patient web portal which provides all staff with training and assistance - this bundle should be  commenced within 24hours of the AKI alert being recognised.
  • undertake a lot of work on fluid balance monitoring and run an AKI and sepsis study day. 




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