Thousands of kidney victims could be saved ...by a glass of water
THIRTEEN thousand patients are dying needlessly in hospital each year from a type of kidney failure caused by dehydration. Yet all the deaths could be avoided with better care and awareness by doctors and nurses, claim specialists.
Experts say acute kidney injury (AKI) is one of the biggest challenges facing the NHS today with the condition claiming the lives of more than 1,000 patients a month, with many developing it while in hospital for an unrelated illness.
Lack of fluid leads to a severe drop in the kidneys’ ability to filter toxins in the blood and expel waste through urine. The toxins build up, leading to fatal kidney failure.
Patients who survive may need a kidney transplant.
The elderly and those with other chronic health concerns such as heart disease or diabetes are particularly at risk.
There have been numerous reports about the problem, including a National Confidential Enquiry into Patient Outcome and Death in 2009 which found that just half of UK hospitals had in place ‘good practice’ procedures for identifying and treating AKI.
Last week NHS Improvement – which is charged with raising patient safety standards – issued a new safety alert reminding doctors to be aware of the signs of AKI.
The condition can occur in a number of ways, as a result of an illness or due to medication. But it can also occur due to a simple lack of water being drunk in hospital.
Symptoms such as a major reduction in the amount of urine passed, nausea and vomiting, abdominal pains, confusion and drowsiness, may be overlooked if they are mild and patients can be misdiagnosed because they could be caused by other conditions.
The only way to check kidney function and spot AKI is with a blood test that analyses levels of creatinine – a chemical waste produced by the muscles.
Healthy kidneys filter creatinine and other waste products from the blood and these are excreted in the form of urine. Higher levels of creatinine in the blood indicate poorer kidney function.
To try to tackle the problem the NHS has set up the Think Kidneys Campaign, offering resources to help people understand and recognise those at risk of AKI, its detection – including carrying out the blood test on all emergency admissions – treatment and management.
Consultant kidney specialist Richard Fluck of Derby Royal Hospital, chairman of the campaign, said: ‘There has to be a much better awareness that hospital treatment for one condition can lead to serious harm due to AKI.’
And Dr Mike Durkin, NHS national director for patient safety, said: ‘Acute kidney injury contributes to around 40,000 deaths every year in England, around 13,000 of which are preventable, and yet it is not known by the public and not always recognised by clinical staff.’
The cost to the NHS of missed diagnosis is put at £200 million.
This figure includes the expense of caring for the 1,400 patients a year who survive AKI but then need dialysis – a treatment that involves a machine taking over the role of the kidneys and clearing the blood of toxins.
One survivor is Ruth Briggs, who owes her life to a doctor in an urgent care centre recognising the danger signs of AKI.
Earlier this year the 53-year-old from Uttoxeter, Staffordshire, visited her doctor with pains in her hips arms and feet, and sickness.
After weeks of investigations, during which Ruth complained of low urine output and blood in her urine, alongside increasing pain and sickness, she was finally referred to an urgent care centre.
‘Within an hour I was being sent to A&E,’ she says. ‘I have that urgent care doctor to thank for saving my life. I’ve been told that if it had been left any longer I would have died.’
A blood test at A&E revealed Ruth was severely dehydrated and that her kidneys had all but stopped functioning – she was suffering from AKI. She was given intravenous fluids before being transferred to a specialist unit where she had six rounds of dialysis.
RUTH was eventually diagnosed with a disease called vasculitis which had caused a decrease in kidney function, joint pain and sickness. Although her condition is now stable, the damage means she will need kidney transplant within the next two years.
She said: ‘A transplant is a virtual certainty as my kidney function will decline.
‘This could have been avoided if doctors had been more alert to the fact I was making hardly any urine and that I had blood in it.’
Dr Fluck, whose hospital – the Derby Royal – was where Ruth was treated, said: ‘Our kidneys are so vital to our well-being yet as medical professionals we have not been as alert as we could be to signs when they are in distress.
‘We are working really hard to drive down the death rate with our awareness campaigns for doctors and patients. We hope, over the next couple of years, to see signs of an improvement.’
More information at the website thinkkidneys.nhs.uk.