Alert over thousands of 'needless' kidney deaths
Thousands of hospital patients are dying needlessly every year from kidney problems that could be treated, according to new NHS guidance.
Between 12,000 and 42,000 deaths could be prevented every year if patients received the best possible care.
Around 100,000 cases of acute kidney injury (AKI) – previously called acute renal failure – could also be stopped across England with simple checks such as ensuring patients are hydrated and their medicines are reviewed.
A new guideline from the National Institute for Health and Care Excellence (Nice) says AKI costs the NHS between £434 million and £620 million a year – more than it spends on breast, lung and skin cancer combined.
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AKI refers to a loss of kidney function and can develop very quickly. It can occur in people who are already ill with conditions such as heart failure or diabetes, and those admitted to hospital with infections.
AKI can also develop after major surgery, such as some kinds of heart surgery, because the kidneys can be deprived of normal blood flow during the procedure.
If the condition is not picked up quickly it can lead to the kidneys shutting down, which can cause severe illness and death.
Between 262,000 and one million people admitted to hospital as an emergency will have AKI, of which just under a quarter will die. Of these, between 12,000 and 42,000 deaths could be prevented if patients received good treatment, according to Nice.
A 2009 report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found only half of all patients with AKI had received good care, dropping to a third of those who developed it while in hospital. A third of patients suffered due to inadequate investigations, including health staff not carrying out "simple" and "basic" checks.
Staff were also found to be "poor" at recognising symptoms and did not always refer patients to kidney specialists in time, while drug prescribing errors contributed to some deaths.
Dr Mark Thomas, chair of the new guideline development group and nephrologist at the Heart of England NHS Foundation Trust, 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."
He said the NHS had made "continuing improvements" since the NCEPOD report, which itself had prompted Nice to develop new guidelines.
"It's now really over to the wider NHS to implement the guidance, which we believe can save both lives and money," he said.
The new guideline says NHS staff should measure serum creatinine levels – a marker of kidney function – in those with existing conditions such as heart failure, liver disease, diabetes, a history of kidney problems or blood poisoning.
Patients taking common drugs such as ibuprofen, ARBs or ACE inhibitors for high blood pressure and other conditions, or diuretics, should also be monitored closely as these can have a negative impact on kidneys.
Other basic checks include measuring urine output and ensuring a patient is not dehydrated, the guideline said.