P17
SURVEY OF GENERAL AWARENESS OF RISK ASSESSMENT, IDENTIFICATION AND
MANAGEMENT OF ACUTE KIDNEY INJURY (AKI) AMONG JUNIOR DOCTORS IN A DISTRICT
GENERAL HOSPITAL IN THE NORTH OF ENGLAND
Kazmi, I1, Briggs, V2, Kawar B2,
1.Barnsley Hospital NHS Foundation Trust, Barnsley, UK, 2. Sheffield Kidney Institute, Sheffield Teaching
Hospitals NHS Foundation Trust, Sheffield, UK.
INTRODUCTION: AKI (previously known as acute renal failure) is associated with high morbidity and
mortality and is seen in 13-18% of all patients admitted to hospital. Inpatient mortality from AKI varies
considerably but in the UK it is estimated to be as high as 25-30%. This can be reduced significantly if the risk
assessment and identification is carried out early in the course of a patient’s illness. The aim of this basic survey
was to assess general awareness of junior doctors in risk assessment, identification and management of AKI in an
acute admissions unit in a district general hospital without onsite renal services. The average daily admission rate
of this district general hospital is 45-55 patients per day.
METHOD: A written survey questionnaire was sent to all junior doctors in all medical and surgical departments
including hematology and ENT. Junior doctors surveyed included foundation year 1(11), Foundation year 2(7),
core medical trainees (4), and locum senior house officers (1). The survey was anonymous and was comprised of
9 questions relating to risk assessment for AKI in acute medical admissions, medication review in event of AKI,
identification of AKI and management including investigation and nephrology referral. The survey questions
were developed using the current Renal Association Guidelines 2011. Of 30 distributed surveys, 23 completed
forms were received.
RESULTS: Most junior doctors surveyed would have a low threshold for investigating a patient for AKI if they
had a history of sepsis/malignancy/previous AKI or were deteriorating clinically (100% of respondents). Fewer
would investigate those with diabetes (82%) or neurological disease (52%) even if an acute admission. 100%
were able to correctly identify that Non-steroidal anti-inflammatory drugs (NSAID) have nephrotoxic effects and
Angiotensin Converting Enzyme Inhibitors (ACEi) can contribute to AKI. However, only 56% would temporarily
stop the ACEI if a patient presented with infection or diarrhoea. 43% did not consider Angiotensin receptor
blockers (ARBs) to have an effect on renal function. 22 of 23 respondents would request a urine dip in a patient
with suspected AKI within 6 hours of admission however only 19 of 23 would offer an ultrasound of the renal
tract in all patients. All of those surveyed would offer ultrasound if urinary tract obstruction or pyelonephritis was
suspected. All respondents felt that early advice from nephrology team would be associated with better patient
outcomes.
CONCLUSION: This pilot survey highlights variation in knowledge and practice amongst junior doctors based
in a single district general hospital. There is a clear need for ongoing education of all clinicians in the
management of AKI including general practitioners (GPs), as early recognition in the community reduces both
mortality and morbidity. This education should aim to promote a multidisciplinary approach to the management
of AKI. This survey only captures a small proportion of UK junior doctors and further work may focus on
implementing management tools (e.g. care bundles/prescribing alerts) to promote risk factor identification on
admission. Development of local guidelines and audit tools in conjunction with education will be the next step to
improve care in the patient with AKI.