Chronic kidney disease and acute kidney injury work programme

What is the programme and its aim?
The programme aims to support improved management of chronic kidney disease and acute kidney injury which is a priority programme as part of the Clinical Network's 2014/15 business plan.

It will support clinical commissioning groups to work with GP practices to:

  • Upskill GPs and other primary care staff on management of chronic kidney disease and acute kidney injury
  • Roll-out of the use of Impakt (Improving Patient care and Awareness of Kidney disease Together) chronic kidney disease tool by clinical commissioning groups to improve chronic kidney disease diagnosis and management in primary care in line with NICE guidelines
  • Implement an improvement programme in primary care aimed at improving the prevention of acute kidney injury and the detection and management of patients with acute kidney injury

Available Quality and Outcomes Framework data suggests there are significant opportunities to improve the management of patients with chronic kidney disease across the East Midlands by better detection and monitoring, controlling blood pressure to evidence based targets, addressing cardiovascular risk factors and appropriate medicines management. A key priority is to reduce the variation within and between clinical commissioning groups. For acute kidney injury, there is delay in recognition of acute kidney injury in hospital in 43 per cent of cases (NCEPOD Report 2009) and basic examination/tests are inadequate in 33 per cent of cases.

61 per cent of acute kidney injury cases arise in the community; 39 per cent are hospital acquired. Most trusts in East Midlands have developed alert systems to support early identification of people with acute kidney injury when admitted to hospital as well implementing educational programmes for medical and nursing staff to improve management. Trusts are currently piloting or implementing other approaches to the management of acute kidney injury including the use of care bundles and acute kidney injury outreach teams. These changes have the potential to lead to significant reductions in deaths from acute kidney injury. Acute kidney injury management in primary care is at a much more embryonic stage both in terms of detection methodology and general awareness/ education within primary care. Nevertheless some of the potential interventions are relatively straightforward (e.g. the use of sick day rules for patients at risk of acute kidney injury)

There is a significant opportunity to improve outcomes for patients and provide cost efficiencies through better care. Working across primary and secondary care, the East Midlands Cardiovascular Clinical Network plans to support a programme to deliver improvements in:

  • prevention of acute kidney injury
  • identifying who is at risk and early detection of patients with acute kidney injury
  • interventions to improve management and outcomes
  • multi professional and patient education.
We are a partner to the national ASSIST-CKD programme and will be leading work in East Midlands to support implementation of the e-GFR surveillance programme. ASSIST-CKD aims to improve the treatment and outcomes of patients who have chronic kidney disease with a focus on those whose declining kidney function may ultimately require dialysis or a kidney transplant.

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