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Around three million people in the UK have kidney disease

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Acute Kidney Injury Clinical Study Group

Acute Kidney Injury Clinical Study Group

Acute kidney injury (AKI) is a sudden reduction in kidney function. It is not a physical injury to the kidney and usually occurs without symptoms.

In England over half a million people sustain AKI every year with AKI affecting 5-15 per cent of all hospital emergency admissions. As well as being common, AKI is harmful and often preventable, thus representing a major patient safety challenge for health care. There is also a need to generate high quality research to inform improved ways of diagnosing, stratifying and managing AKI.

Who we are

We are a national group dedicated to initiating and supporting clinical research into Acute kidney injury.

Our group is jointly chaired by Dr John Prowle, Senior Clinical Lecturer in Intensive Care Medicine within the Critical Care and Perioperative Medicine Research Group, London; Dr Lynne Sykes, Renal and General Internal Medicine trainee, Salford Royal NHS Foundation Trust; and Dr Mark Thomas, Consultant Nephrologist at the Heart of England NHS Foundation Trust.

Dr John Prowle
Dr John Prowle
Dr Lynne Sykes
Dr Lynne Sykes
Dr Mark Thomas
Dr Mark Thomas

Our aims:

  • To generate research ideas for clinical studies in AKI
  • To identify and communicate priority areas for clinical research into AKI
  • To provide a resource to assist investigators in developing or refining clinical research studies
  • To facilitate collaboration between investigators involved in AKI clinical research

If you have a research idea or proposal we would like to hear from you. Working with us we can help investigators in the acquisition of grant funding, provide advice about study design, facilitate potential collaboration and our involvement can be cited in funding applications.

We aim to align research to clinical questions that are important and relevant to NHS practitioners. By working closely with key implementation organisations, such as NHS England, we have started to show what the UK can offer in the area of research development and delivery.

Evidence gaps and challenges:

AKI is a sudden or rapid decline in kidney function that can lead to hospital admission, longer hospital stays, increased mortality risk and long-term kidney damage, and it costs the NHS more than £1billion a year. It is difficult to stratify individual patients in terms of their diagnosis, assessment of severity and long-term outcomes as:

  • AKI is a diffuse syndrome with multiple aetiologies, and severity and clinical course vary significantly between individuals and clinical settings.
  • AKI is currently defined using changes in serum creatinine concentration, but this provides no information on the type or severity of renal injury. Tools to discriminate between patients with hypovolaemia and those with renal tubular cell damage are lacking.
  • Long-term effects of AKI may only be apparent after several years or even decades (particularly in children). Stratification of patients’ risk of developing CKD would inform improved follow-up and intervention.

Key projects:

  • AKI Network - developing a national AKI network and infrastructure for high quality patient phenotyping and biosampling which focuses on mechanisms of disease.
  • Stratification of AKI stage 1 using Neutrophil Gelatinase Associated Lipocalin - prior to larger clinical studies of biomarker-based approaches to patient stratification, technical validation of commercially available biomarker assays is being undertaken. Target population is hospitalised patients with AKI stage 1.
  • RISK follow-on study - intervention RISK score (+/- additional biomarker stratification) linked to intervention versus current standard of care in medical assessment unit (MAU) patients. Proposal under development.
  • Early fluid management for AKI guided by advanced haemodynamic monitoring - can technology improve fluid replacement strategies in people with AKI in emergency departments/MAUs?
  • Evaluating the clinical and cost-effectiveness of sodium bicarbonate administration for AKI in critically ill patients - does this improve outcomes?

Find out more about other AKI studies on the NIHR portfolio.

Impact of some of our studies:

Tackling AKI study - measuring the impact of a package of interventions (e-alerts, a care-bundle and a programme of education) on the delivery of AKI care and patient outcomes in five UK hospitals. Published in JASN March 2019, 30 (3) 505-515.

 

Combined with previous evidence, the result show that strategies to improve the systematic delivery of supportive AKI care can lead to improvements in patient outcomes, and the reduction in hospital stay could translate into significant health economic benefits, given the large numbers of people who develop AKI.

 

The RISK study - a UK-wide study in 72 acute medical units (AMUs) to determine risk factors associated with hospital-acquired AKI (hAKI) and the feasibility of developing a risk prediction score. Published in QJM: An International Journal of Medicine, Volume 112, Issue 3, March 2019, 197–205.

 

These results have helped inform approaches to AKI risk assessment in medical assessment units (MAUs).

Got a question? get in touch.

For more information and to find out about getting involved as a patient or researcher, contact:

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