Background COVID‐19 is associated with increased risk of acute kidney injury (AKI). Risk factors and biomarkers linked to AKI have now been recognized by national guidelines in the United Kingdom. This analysis aims to validate and expand the comorbidities and biomarkers associated with the presence and severity of AKI in these patients. Methods Data were extracted via structured query language for patients with COVID‐19 at University Hospital Southampton between 1 March and 10 June 2020. Demographics, comorbidities, common biomarkers and AKI stage within 48 hours of admission, peak during admission and the last measurement prior to patient outcome (discharge or death) were collected and statistically analysed. Results Six hundred and thirty‐two COVID‐19 positive patients were admitted during this period; 34.2% had an AKI during their entire admission, 20.3% had AKI stage 1, 8.5% stage 2 and 5.4% stage 3. This was higher when compared with data from the same period in 2019. AKI carried an increased risk of death, 50.0% vs 21.1% (P = <.001). AKI stage was significantly associated with age over 65, diabetes, heart failure, peripheral vascular disease, haematological malignancy, hypertension, respiratory rate, albumin, C‐reactive protein (CRP), d‐dimer, ferritin, high‐sensitivity troponin‐I, neutrophil count, total white cell counts, National Early Warning Score‐2 (NEWS‐2), Charlson comorbidity index and alanine‐aminotransferase. COVID‐19 specific treatment, including dexamethasone, reduced discharge creatinine. Conclusion COVID‐19 increases the risk of AKI and this kidney injury may be responsive to treatment. This analysis identified that AKI is associated with both previously described and new comorbidities and biomarkers.
Acute kidney injury (AKI) is a common health issue. It is a sudden episode of kidney failure that is almost entirely associated with episodes of acute illness. AKI is common with as many as 20% of patients arriving at hospital having an AKI, with up to 15% of patients developing AKI in a postoperative period. Patients who have an episode of AKI are more likely to have a further episode of AKI and require readmission to hospital. This project aimed to provide patients with AKI education for self-care and management, with the hope of reducing AKI readmissions.Using quality improvement methodology, the AKI patient discharge and readmission pathway was reviewed, and information about AKI was given to patients. This was in the form of verbal information and a patient information leaflet. This information was provided on discharge from acute care.Baseline data were collected that showed more than 80% of patients reported that they were not given information about AKI prior to their discharge from hospital. Due to higher readmission rates, the focus of this improvement project was on acute medical wards. Following implementation, there was a sustained reduction in AKI patient readmission rates. This reduction led to a significant reduction of inpatient bed days and a shorter length of stay for those patients who were readmitted. Quality improvement methods have facilitated a successful reduction in acute AKI readmission to hospital.
Acute kidney injury (AKI) is a common occurrence among hospital patients, with patients being cared for by a wide range of health care specialties, rather than purely under the care of nephrologists. Patients with severe AKI are known to have poorer outcomes if they do not receive appropriate follow-up and medication reviews. Following the successful implementation of a nurse-led AKI follow-up clinic, a service evaluation was undertaken to assess whether there had been any impact on patients' knowledge of AKI. Patients were asked to assess their perceived knowledge about AKI before and after attending an AKI nurse-led clinic appointment. The results found that patients were more knowledgeable following attendance at clinic and felt reasonably confident in preventing future AKI.
Acute kidney injury commonly starts in the community. Becky Bonfield explains how practice nurses can help to identify the condition to improve patient outcomes Acute kidney injury is a common and under-recognised disorder associated with both morbidity and mortality, which often leads to the development of chronic kidney disease ( Lewington et al, 2013 ). While acute kidney injury was previously thought to be completely reversible, with no long-term health implications for patients who recovered, there is growing evidence that even a single transient acute kidney injury can lead to permanent organ damage ( Coca et al, 2012 ). It is important for staff in primary care to be aware of acute kidney injury and its causes, as up to 65% of acute kidney injuries will start in the community setting ( Selby et al, 2012 ). Being able to understand the common risk factors for acute kidney injury can assist in early diagnosis and treatment, which can improve patient outcomes.
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