Professional Documents
Culture Documents
• Recommendations
• Discussion
June 2009
Implementing NICE guidance www.nice.org.uk
Background: prevention and early
identification
• AKI can be readily identified by close monitoring of routine
serum creatinine and urine output results
Use an
early warning score
that recognises
and responds to
deterioration
and acute illness
Covers:
Adults (excluding pregnancy and renal transplant patients)
Young people and children older than 1 month (excludes
neonates)
* not a KPI, but considered a key issue by the guideline development group
Implementing NICE guidance www.nice.org.uk
Risk factors: adults
• Chronic kidney disease (or history of)
• Diabetes
• Heart failure
• Sepsis
• Hypovolaemia
• Age 65 years or over
• Use of drugs with nephrotoxic potential (for example,
NSAIDs, ACE inhibitors)
• Use of iodinated contrast agents within past week
• Oliguria
• Liver disease
• Limited access to fluids, e.g. via neurological impairment
• Deteriorating early warning scores
• Symptoms or history of urological obstruction
* Urine output of less than 0.5 ml/kg/hour more than 8 hours in children and young people
• Pharmacological management
• Referral
• Discuss future risk of AKI, especially for patients with eGFR < 60 or
those with neurological or cognitive impairment. In particular, discuss
the risk associated with:
An online tool
providing
quick and
easy access,
topic by topic,
to the full
range of
guidance
from NICE
Click here to go
the pathway
Click here to go t
o NICE Evidence Se
rvices AKI page
• The clinical questions are based on the clinical areas in the scope and
are formulated into PICO method questions:
• Population
• Intervention
• Comparison
• Outcome(s)
•The NICE PATHWAY is on an online tool for health and social care
professionals that brings together all related NICE guidance, quality
standards and implementation tools on a topic in a set of interactive
flowcharts.