Thousands of patients are dying unnecessarily because hospital doctors are missing the signs of kidney failure, a national inquiry reports today.
Half of people who die from acute kidney injury (AKI) do not receive a good standard of care because of lapses in “basic bedside medicine”, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) says.
AKI, also known as acute renal failure, is estimated to affect up to 5 per cent of all hospital patients, but there are “systematic failings” in identifying and treating patients with the condition.
Estimates suggest that at least 2,000 patients die every year from AKI, brought on by dehydration and the side-effects of medication.
The NCEPOD report on 564 patients who died in hospital found that in 43 per cent of cases, there was an unacceptable delay in diagnosing their condition, while in 13 per cent of cases, fatal complications were missed.
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Complications were also “avoidable” in 17 per cent of cases and “managed badly” in 22 per cent of cases.
The report found failings in basic bedside medicine — the way doctors cared for patients, rather than in the way hospitals organised the care.
This included doctors failing to carry out basic tests to check for kidney failure — the study found 33 per cent of patients had had inadequate investigations.
The inquiry focused on the case notes of patients who died from AKI in 215 hospitals between January and March 2007. The hospitals were in England, Wales, the Channel Islands and the Isle of Man.
James Stewart, a joint author of the report and NCEPOD’s clinical co-ordinator, said that the findings indicated a lack of awareness among doctors of the risks of renal failure, a poor understanding of how the condition progressed and inadequate knowledge of how to manage it.
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“AKI is a common and essentially treatable condition, but a lack of basic bedside medicine is leading to the deaths of at least 2,000 patients a year in this country. The very essentials of medical care were being omitted and, unless attention is paid to the basics, patients will continue to die unnecessarily.”
AKI is distinct from chronic kidney disease, which requires regular treatment with dialysis. It can be identified through a blood test, but the inquiry found that the condition was often recognised late when complications were already evident.
“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,” Dr Stewart added. “Leaving complex and potentially reversible problems to junior staff is always unacceptable.
The NCEPOD report, Adding Insult to Injury, recommends that all patients admitted to hospital as an emergency should have a blood test to check electrolyte levels, which indicates how well the kidneys are functioning.
Dr Stewart said that the condition was more likely to affect elderly patients but could also result from a lack of fluids, or as a side-effect of common drugs including aspirin, blood pressure medication and antibiotics.
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He pointed to the failure of undergraduate and graduate medical training as a key factor in the inadequate care of AKI patients: “Education is paramount, but medical student training does not provide junior doctors with the ability to recognise acute illness.”
The inquiry recommended that medical training should promote greater awareness of the condition. All patients in hospital should also be reviewed by a senior consultant within 12 hours of admission, it added.
Ann Keen, the Health Minister, said: “We are grateful to NCEPOD for bringing this to our attention. “Predictable and avoidable acute kidney injury should never occur.”