Inequalities in outcomes of acute kidney injury in England

Abstract

The country has created specialist renal units in 45% of hospital trusts, but AKI presents as emergencies to all hospitals and there is an increased risk of mortality in the 55% of trusts without renal specialists.

The Use of Automated Electronic Alerts in Studying Short-Term Outcomes Associated with Community-Acquired Acute Kidney Injury

“…Abraham et al [20] used ICD coding, followed by manual confirmation of AKI and reported a 30-day mortality of 30% compared to our finding of 25%. Our duration of hospital stay (median of 6.6 days) is similar to that reported by Wonnacott et al [10] for c-AKI patients (median: 7 days) but somewhat lower than that reported by Selby et al [9] (median: 9 days) which included all hospitalized patients with AKI (both c-AKI and h-AKI).…”

Variation in gastroscopy rate in English general practice and outcome for oesophagogastric cancer: retrospective analysis of Hospital Episode Statistics

“…Each care episode contains administrative information (eg, dates of admission and discharge, method of admission), a primary diagnosis and up to 13 secondary diagnoses (coded according to the ICD-10 system), and up to 14 procedure fields coded using OPCS-4 system (Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures 4th revision) 14 15. The quality of HES data has been validated,16 and this dataset has been used recently to study surgical outcome in OG cancer 17…”

“…Deaths were derived through a linkage between HES records and the Office of National Statistics (death registrations), hence, capturing deaths both in and out of hospital 14 15…”

Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle

“…[1][2][3] AKI can affect patients across all medical and surgical specialties, with only a small minority of cases being directly under the care of nephrologists. 4 To date, there are no specific therapies and the emphasis is on early detection, optimisation of haemodynamics and fluid status, avoidance of nephrotoxic drugs and initiation of appropriate diagnostic investigations. In 2009, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) identified significant failings in recognition and deficiencies in the management of AKI in hospitals in the UK.…”