ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

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

Authors

  • 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)
Background

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.

Methods

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.

Results

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.

Conclusion

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.

 Pre-interventionPost-interventionP-Value
HOSPITAL A% AKI
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
HOSPITAL B% AKI
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
HOSPITAL C% AKI
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