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Prospective audit October 2011-October 2012 Acute Kidney Injury at Dorset County Hospital renal unit Dominic Taylor ST4 Nephrology Dorset County Hospital Slide 2 NCEPOD: Adding insult to Injury (2009) Only 50% of AKI care considered good Poor assessment of risk factors Appropriate investigations (Ultrasound, urine dip) not always performed Senior review within 12 hours recommended Renal referrals were delayed in 20% Timely, appropriate specialist advice and transfer needed. Slide 3 Dorset County Hospital Nephrology service Large geographical area, population >850,000 Outreach service and clinics at YDH, RBH and PGH Slide 4 Aims Assess adequacy of care from Nephrology and non- Nephrology teams. Aim to implement guidelines to alter management and continuous re-audit. Slide 5 Inclusion criteria October 2011- October 2012 Patients transferred to renal ward at DCH from other ward or hospital, with a diagnosis of AKI. Electronic and written notes review. Slide 6 Demographics 51 patients 26 Male 25 Female Mean age at presentation 68 years (22-90) Median age 72 years Slide 7 Referrals 26(51%) from within DCH 25 transferred from other hospitals 32(63%) from medical teams ReferrermedicalsurgicalITUTOTAL DCH175426 YDH3014 RBH54514 PGH6006 Salis1001 TOTAL3291051 9(18%) surgical 10(20%) ITU Slide 8 Length of stay Mean LoS 7.5 days for medical patients at DCH Mean Length of stay 17 days Slide 9 Risk Factors Slide 10 Aetiology Pre-renal' sepsis14 D&V/GI upset4 post-op3 GI bleed1 cardiorenal1Renal' Glomerulonephritis ANCA vasc7 Interstitial nephritis2 other vasculitis1 Systemic disease haemolysis/blackwater fever1 Myeloma3 Iatrogenic Post angio/contrast2 Vanc/Gent2 ACEi toxicity2 Ingestion NSAIDS2 Ethylene Glycol1 metabolic Rhabdomyolysis4 Hypercalcaemia1Post-renal' RPF/malignancy5 Retention2 Calculus2 Slide 11 Referring team management Slide 12 Timing of Imaging Slide 13 Referral and response Renal referral within 24 hours of AKI? Advice or review within 24 hours of referral? Transfer to renal unit within 48 hours of referral? %69100 72(85 excluding ITU on support) Slide 14 Outcomes 34 received haemodialysis acutely 11 of these haemofiltered on ITU In-hospital death: 5 (10%) Death within 3 months: 10 (20%) 7 (14%) needed permanent RRT (all HD) DialysisDeath Baseline eGFR AKI DEFINITION (Creatinine increased >26mol/L in 48 hours Creatinine >1.5x known reference value or UOP