NCEPOD report into acute kidney injury fails to recognise systematic failings in organisation of renal services
The recent NCEPOD report into acute kidney injury whilst recognising
the role acute kidney injury plays in the mortality and morbidity of
emergency admissions fails to identify some important issues.
The authors rightly emphasise the need for early recognition and
prevention of this condition, however there reaches a point in this
condition where readily implementable measures that can be provided on the
general ward are unlikely to reverse the decline. The need then is to be
able to gain rapid access to renal replacement therapy - and this is where
problems often occur.
Renal services are organised nationally on a hub and spoke model.
Unfortunately this model is designed for chronic renal disease with a
'hub' tertiary hospital based renal unit from which there are 'spokes'
into primary and secondary care for dialysis units and renal clinics. This
historical model leads then to confusion for clinicians as to who they
should approach in order to manage their deteriorating patient.
Acute kidney injury should be disconnected from this model and specialist
commissioners need to recognise this. Untimely delays in trying to access
an acute bed at the nearest tertiary unit only leads to further
deterioration and is often futile. Access to urgent renal replacement
therapy is a higher priority than 'an opinion'.
In most acute hospitals renal replacement therapy is only provided in
critical care units. Commissioners should recognise and fund this and
recognise the role of their local critical care units in providing this
Competing interests: No competing interests