Assessing the impact of acute kidney injury in secondary care and developing strategies to improve outcomes

Abstract

Abstract: Assessing the impact of acute kidney injury in secondary care and developing strategies to improve outcomes (Dr Lynne Sykes) Introduction: Acute kidney injury (AKI) is associated with up to one in five emergency admissions to hospital and over 300,000 deaths per year in the UK. This thesis, presented in the alternative format, examines work undertaken to better describe the etiology of AKI in secondary care and then strategies to reduce AKI incidence, progression and complications. Methods: Selected anonymised data from the hospital’s ‘data warehouse’ was analysed using SPSS to calculate risk for mortality and critical care admission, analyse background user data, or calculate precision and bias of different point of care tests. The International Health Institute’s Breakthrough Series Model was used for our quality improvement methodology. Results: The literature review suggested education, an e-alert to trigger an AKI bundle and an in-built redundancy in the system were key to reducing mortality and critical care admission. The literature also demonstrates a high event rate of AKI and significant heterogeneity in cause and patient phenotype. The first three results chapters describe the epidemiology of our cohort of secondary care AKI patients in more detail. Chapters 3 and 4 examine the risks of different stages of AKI and the impacts they have on mortality, depending on admission diagnosis. Chapter 3 shows stark differences between patient mortality in those admitted with acute coronary syndrome and AKI 3 compared to those without AKI (OR 12.8 [4.8-33.8] p

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Philip Kalra (Supervisor), Darren Green (Supervisor), James Ritchie (Supervisor) & Robert Nipah (Supervisor)