Quality standard

Quality statement 1: Raising awareness in people at risk

Quality statement 1: Raising awareness in people at risk

Quality statement

Children, young people and adults who are at risk of acute kidney injury are given advice on maintaining kidney health. [2014, updated 2023]

Rationale

Many people at risk of acute kidney injury do not know about the potential causes or what they can do to reduce their risk. If people are aware of the risks and how to maintain their kidney health, they may be able to prevent acute kidney injury. Providing advice to people who are at risk of acute kidney injury, and their families and carers, may help to reduce the number of people developing acute kidney injury (both in the community and while in hospital) and admitted to hospital with it.

Quality measures

The following pragmatic measure is suggested to help assess the quality of care or service provision specified in the statement. It is an example of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of people with chronic kidney disease (estimated glomerular filtration rate [eGFR] less than 60 ml/min/1.73 m2), diabetes, heart failure, dementia, a learning disability or a previous episode of acute kidney injury who were given advice on maintaining kidney health at their most recent annual health review.

Numerator – the number in the denominator who were given advice on maintaining kidney health at their most recent annual health review.

Denominator – the number of people with chronic kidney disease (eGFR less than 60 ml/min/1.73 m2), diabetes, heart failure, dementia, a learning disability or a previous episode of acute kidney injury.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices, pharmacies and hospitals) ensure that processes are in place for people who are at risk of acute kidney injury, and their families and carers if appropriate, to be given advice on maintaining kidney health. This could be included as part of annual health reviews for people with chronic kidney disease, diabetes, heart failure, dementia, a learning disability or a previous episode of acute kidney injury.

Healthcare professionals (such as GPs, pharmacists, nurses and advanced clinical practitioners) provide advice on maintaining kidney health to people at risk of acute kidney injury, and their families and carers if appropriate. This can be done at annual health reviews for people with chronic kidney disease, diabetes, heart failure, dementia, a learning disability or a previous episode of acute kidney injury.

Commissioners (integrated care boards and NHS England) ensure that they commission services that provide advice on maintaining kidney health to people at risk of acute kidney injury, and their families and carers if appropriate.

People who are at risk of acute kidney injury,and theirfamily and carers if appropriate, are given advice about how to keep their kidneys healthy. This should include explaining possible causes of acute kidney injury (for example, dehydration caused by diarrhoea and vomiting, and certain drugs that can affect the kidneys) and what they can do to avoid it.

Definitions of terms used in this quality statement

People at risk of acute kidney injury

An increased risk of acute kidney injury is associated with a range of chronic and acute conditions, medicines and social factors. Risk factors for adults are identified in the NICE clinical knowledge summary on acute kidney injury, risk factors. Risk factors for children are identified in Think Kidneys' guidance for clinicians managing children at risk of, or with, acute kidney injury, section 5.

Advice on maintaining kidney health

Healthcare professionals should discuss the potential causes of acute kidney injury and how people at risk can maintain their kidney health. The potentially preventable causes of acute kidney injury include conditions leading to dehydration (for example, diarrhoea and vomiting) and drugs that can cause or exacerbate kidney injury (including over-the-counter NSAIDs [non-steroidal anti-inflammatory drugs]). Healthcare professionals should offer written information such as Kidney Care UK's leaflet, At risk of kidney disease? Keeping your kidneys safe. [NICE's guideline on acute kidney injury, recommendation 1.6.4, and NICE's clinical knowledge summary on acute kidney injury, prevention of acute kidney injury]

Equality and diversity considerations

Healthcare professionals should be aware that some groups of people are at higher risk of dehydration because of their reliance on others to maintain adequate fluid intake. This may include young children, frail older people, people with neurological or cognitive impairment or disability, and people with physical disabilities. Healthcare professionals should share advice on maintaining kidney health with families and carers where appropriate.

People should be given information that they can easily access and understand themselves, or with support, so they can communicate effectively with healthcare services. Clear language should be used, and the content and delivery of information should be tailored to individual needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.