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Kidney Week

Abstract: PO0011

Region-wide Implementation of Best Practice in AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Rao, Anirudh, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
  • Abraham, Kottarathil Abraham, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Liverpool, United Kingdom

Group or Team Name

  • On behalf of the Cheshire & Merseyside Acute Kidney Injury Network (CHAMKIN)

The Cheshire & Merseyside Acute Kidney Injury Network, United Kingdom, rolled out best practice guidelines of13 interventions for Acute Kidney Injury (AKI) in October 2014. The aim was to assess the impact of the guidelines.


Setting & Population: Hospitals in Cheshire & Merseyside.
Predictor: Time period before & after introduction, allowing six-month bedding in period.
Outcome: Percentage AKI: Number of AKI per month, divided by total number of admissions/month expressed as %. Percentage AKI deaths: Number of AKI related deaths per month divided by total deaths/month expressed as %.
Data analysis: Descriptive & Piecewise Linear Regression.


The region saw a notable increase in the number of admissions/month (31,173 vs 38,443) and AKI episodes (4,871 vs 44,493) in the 8 hospitals in pre and post guideline implementation period. Five hospitals were excluded due to guideline implementation pre-roll out (2), implementation dates not provided (2) & no pre-implementation data (1). The outcomes in the 2 periods are detailed in the Table. The introduction of E-alert saw an increase in AKI detection across the hospitals. The figure shows longitudinal piecewise regression curves. The most significant reduction was noted in hospital A.


The rollout of interventions caused an increased and sustained recognition of AKI, across the hospitals. The % AKI deaths stayed the same except in Hospital A. We theorise that the onsite nephrology team in Hospital A aided implementation of the guidelines and training of wider healthcare staff which made the impact. This study highlights the hurdles faced in implementing AKI improvement strategies across various healthcare settings.

Median (IQR)
1.1 (1.0-1.9)4.9 (4.7-5.2)0.0001
% AKI deaths
Mean (95% CI)
19.6 (16.9-22.4)16.4 (14.5-18.2)0.05
Median (IQR)
5.2 (1.3-5.7)4.9 (4.6-5.2)0.85
% AKI deaths
Mean (95% CI)
21.1 (18.9-23.3)19.7 (18.6-20.8)0.24
Median (IQR)
4.2 (2.5-5.3)3.3 (2.9-4.7)0.40
% AKI deaths
Mean (95% CI)
7.9 (2.8-12.9)12.8 (5.1-20.4)0.30