Page last updated at 23:03 GMT, Wednesday, 10 June 2009 00:03 UK

Urgent kidney patients 'failed'

Clinical failings were highlighted by the report

Doctors have been failing patients who develop emergency kidney problems in hospital, a national inquiry has found.

The National Confidential Enquiry into Patient Outcome and Death looked at 564 patients who died in hospitals in England and Wales from acute kidney injury (AKI).

It found that 50% of the patients did not receive a good standard of care.

In particular, the report found doctors seriously wanting when it came to diagnosis.

The majority of AKI patients were let down by clinical rather than organisational factors
Dr James Stewart
National Confidential Enquiry into Patient Outcome and Death

There were frequently delays in recognising that someone had the condition, which is accompanied by blood poisoning and fluid loss.

Basic clinical and laboratory tests were not carried out in a third of the patients who died between January and March 2007, while a quarter of cases were not examined by an appropriate specialist.

"The majority of AKI patients were let down by clinical rather than organisational factors," said Dr James Stewart, co-author of the report, Adding Insult to Injury.

"In the past specialist clinical care has rightly focused on chronic kidney disease, but this has left acute kidney injury to be managed by non-specialists."

He said clinical failures in AKI care management were "a microcosm of a more global failure of the sick patient by medical staff.

"I hope that the report will not only inform the debate around acute kidney injury, but also acute patient care in its totality."

'Poor understanding'

AKI is reversible if treated apropriately and promptly.

While there have been no UK studies into the frequency of the condition, NCEPOD said it was a "prevalent and serious problem" among hospitalised patients. It can occur on its own, but usually follows a serious illness, accident or surgery.

Despite its prevalence, the report's authors said their findings from the 217 hospitals in England, Wales, the Channel Islands and the Isle of Man suggested a "lack of awareness" among doctors of the risks.

It also highlighted a "poor understanding" of how the condition progressed or inadequate knowledge of how to manage it.

"It is likely this reflects deficiencies in training, both at undergraduate and postgraduate level, which is of particular note considering the prevalence and clinical importance of AKI," the report said.

There were however organisational issues: in half of hospitals with no onsite kidney specialists - or nephrologists - the nearest were in another city.

NCEPOD recommended that hospitals' admissions policies for all emergency patients should include a risk assessment for AKI and that patients be reviewed by a consultant within 12 hours.

The majority of those who died had been admitted as emergencies.

Government response

Health minister, Ann Keen, said: "We are grateful to the NCEPOD for bringing this to our attention.

"Predictable and avoidable acute kidney injury should never occur.

"We are seriously concerned that some hospitals are failing to follow the quality requirements in National Institute for Health and Clinical Excellence.

(Nice) guidelines and in our strategy for kidney care, the National Service Framework for Renal Services.

"In 2008, we established NHS Kidney Care to drive service improvement locally and will work with the team to support the NHS in ensuring that patients with acute kidney injury get the best possible care."

A spokesperson from Kidney Research UK said: "It's very upsetting to hear from this report that simple urine tests, which can save lives, are not being taken.

"We appreciate the key recommendations from this report and would definitely like to see appropriate basic training at graduate and post graduate level to identify any acute kidney injury."

John Black, president of the Royal College of Surgeons, said the report illustrated how doctors were struggling to cope with the imposition of new rules limiting their hours.

"NHS Trusts are being placed under intolerable pressure to keep services running with less doctor time, and inevitably it is training time that suffers.

"No amount of calls for "innovative solutions" from the Department of Health can change this - the arithmetic simply does not add up.

"Fewer hours, equals fewer doctors on duty, equals less training, and poor patient care is the result."

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