Acute kidney injury: prevention, detection and management - NICE guideline

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The Acute kidney injury: prevention, detection and management clinical guideline offers evidence-based advice on the prevention, detection and management of acute kidney injury up to the point of renal replacement therapy.

Acute kidney injury, previously known as acute renal failure, encompasses a wide spectrum of injury to the kidneys, not just kidney failure. The definition of acute kidney injury has changed in recent years, and detection is now mostly based on monitoring creatinine levels, with or without urine output. Acute kidney injury is increasingly being seen in primary care in people without any acute illness, and awareness of the condition needs to be raised among primary care health professionals.

Acute kidney injury is seen in 13–18% of all people admitted to hospital, with older adults being particularly affected. These patients are usually under the care of healthcare professionals practising in specialties other than nephrology, who may not always be familiar with the optimum care of patients with acute kidney injury. The number of inpatients affected by acute kidney injury means that it has a major impact on healthcare resources. The costs to the NHS of acute kidney injury (excluding costs in the community) are estimated to be between £434 million and £620 million per year, which is more than the costs associated with breast cancer, or lung and skin cancer combined.

The costs to the NHS of acute kidney injury are estimated to be between £434 million and £620 million per year, which is more than the costs associated with breast cancer, or lung and skin cancer combined.

This guideline emphasises early intervention and stresses the importance of risk assessment and prevention, early recognition and treatment. It is primarily aimed at the non‑specialist clinician, who will care for most patients with acute kidney injury in a variety of settings. The recommendations aim to address known and unacceptable variations in recognition, assessment, initial treatment and referral for renal replacement therapy. The inpatient mortality of acute kidney injury varies considerably, depending on its severity, setting (intensive care or not), and many other patient‑related factors, but in the UK might typically be 25–30% or more. In view of its frequency and mortality rate, prevention or amelioration of just 20% of cases of acute kidney injury would prevent a large number of deaths and substantially reduce complications and their associated costs.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

You can read the guideline on NICE's website.