Acute Kidney Injury Gets New Focus
In England, British newspapers picked up on the issue after a paper published in the journal Nephrology Dialysis Transplantation reported an estimated 40,000 "excess" deaths annually in the United Kingdom, with the cost of care eating up 1% of the National Health Service budget. With these numbers in mind, the NHS has set up a nationwide Keep Kidneys Healthy program designed to "measure, educate, and manage better."
The U.K. study found that AKI prevalence in inpatients may be considerably higher than previously thought, and "up to four-fifths of cases may not be captured in routine hospital data."
Like all underdiagnosed conditions, the reported growth of AKI incidence raises the question: Are more patients developing the condition or are doctors getting better at identifying it? Stanley Goldfarb, MD—a professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia, part of 1,637-licensed-bed Penn Medicine—says he wouldn't be surprised if AKI rates were increasing. But he says he thinks the change is being driven by a shift in the patient population and the sensitivity of the new diagnostic criteria.
"We're dealing with sicker and sicker older patients who are getting surgery that we never had dreamed of before," he says. "That puts them at risk for this."
A renal critical care specialist, Goldfarb has mixed feelings about the pending Medicare rule. Contrast-induced AKI is common and can't always be prevented. But he says it can be reduced if hospitals have protocols in place, and the CMS move may push hospitals in that direction. Still, such programs can take time and effort to establish, says Goldfarb, who has consulted with other hospitals on how to set up a monitoring program. For example, logistical questions emerge, such as, Should radiologists or the clinicians administer fluid that can prevent contrast-induced AKI? And, in some cases, the clinicians don't want the hospitals to tell them what to do, he says.
"Having said that, I think it still can be done if you can identify the really high-risk patients and do something about it," Goldfarb says.