Our Work :: North West Kidney Network

Acute kidney injury (AKI) is a sudden loss of kidney function that affects more than half a million people in England per year. It is often associated with episodes of acute illness and results in poor clinical outcomes. AKI is also known to increase individuals’ susceptibility to Chronic Kidney Disease.

There is national and local evidence that suggests AKI in a third of cases is under treated (UKRR, 2020). This workstream is focused on ensuring local systems have robust processes in place covering prevention, detection, and management, based on evidence-based practice (NICE [NG148], 2019; NHS England, 2015).

Aims

Ensuring local systems have robust processes in place covering prevention, detection, and management of AKI, based on best available evidence-based practice (NICE (qs76)NHS England, March 2023) NICE [NG148], 2019; NHS England, 2015).

Objectives

Subgroup 1: Improving AKI detection, prevention, and early management
AKI bundle implementation in line with revised NICE quality standards.
Updating and or improving processes or establishing new AKI services.

Subgroup 2: Improving access to nephrology services and early transfer
Establishing referral pathways for timely transfers between non-renal trust and renal hubs.
Collaboration with critical care network regarding inter centre transfer and ITU step down protocol.
Collaboration with critical care to minimise delay in offering Renal Replacement Therapy

Subgroup 3 Improving post AKI discharge and primary care support workstream.
Post AKI discharge communication to GP
Post AKI discharge medication management
Post AKI follow up where needed.

AKI Prevention: Education, training, and support
Establish the NWAKI Network, and education to providers.

CKD is a long-term condition, where kidney function declines over time. It is associated with poor mortality and morbidity and is a marker of cardiovascular disease. People with diabetes and high blood pressure are at higher risk of developing CKD and it affects over 3.5 million people in the UK with kidney disease now being called a public health emergency (kidney Research UK, 2023).

Around 300,000 people in the NW have been diagnosed with CKD and local data suggests many more are undiagnosed. CKD is often symptomless and early detection and timely interventions can halt progression and improve outcomes.

CKD, in its early stages, is managed in primary care; referral to secondary care is needed when the disease progresses, or when specialist Nephrology management is required. People with CKD or at risk of CKD should be assessed and monitored with the aim of preventing disease progression (NICE [NG203]. RSTP recommends a collaborative whole pathway approach to managing CKD and advises the best practice approach follows seven key principles:

Integrated Kidney Care Clinic
CKD case finding
Coding
Shared decision making
Monitoring and risk reduction
Integrated CKD dashboards
Education and training of health care professionals.

Data in the NW indicates there is wide variation across several of the pathway stages. To address these inequalities the NWKN has three CKD workstreams, one for each ICB. These three workstreams have individualised aims that are based around the ICB they serve. All aims are focused on common drivers for change as set out in several national recommendations.

Improve screening and detection in at risk populations
Improve accuracy of coding
Increase CKD patients receiving highly evidence-based treatment
Reduce the rate of late presentation for RRT
Reducing unwarranted variation in health inequalities
Transformation and modification of Joint MDT Clinics Secondary and Primary care.

Patients will require Renal Replacement Therapy (RRT) to sustain life once kidney disease progresses to End Stage Kidney Disease (ESKD). Some will receive a kidney transplant, and others will require dialysis.

Dialysis can be challenging for patients and ensuring the treatment is suitable with favourable outcomes is essential to maximising patients’ quality of life. There is known variation across the region in the uptake of home dialysis therapies. The Getting it right first time (GIRFT) report on renal medicine (GIRFT, 2021) has recommended 20% uptake of home dialysis therapies in all Kidney units.

Capacity for Dialysis

Capacity and delivery for dialysis therapy across the region has been highlighted as an ongoing risk in 2023-24. The network has worked alongside the five provider organisations to gather data on growth and gaining an insight into nursing staffing models across the region. We have also run a pilot project on a dialysis acuity score within our Workforce and Education workstream with a progress report due in April 2024.

The NWKN, alongside Renal Clinical Directors and Clinical Network Leads, escalated services seeing significant increase in growth to the Internal Medicine Programme of Care (IMPOC) group in the NW in December 2023. Growth across some services has been acknowledged and the region and awaiting the outcomes of further discussions.

Aims

To optimise dialysis experience for all patients and reduce unwarranted variation.
To create a culture of confidence in home dialysis through clinical leadership and enhanced engagement.

Objectives

Increase uptake of home therapies across all units.
Improve rates of medical PD Catheter insertion and Urgent-start PD
Establish regional QI metrics and establish data flow for the Renal dashboard.
Work alongside the vascular access teams to optimise timely access formation and preservation of function.
Link in with workforce workstream to identify ways to provide quality care and support for patients receiving Dialysis treatments.

Evidence indicates many young people are lost to follow up when transferred to an adult system, can be disengaged, and have sub-optimal health and life outcomes when not cared for in a holistic way. The NCEPOD report ‘The Inbetweeners’ [2023] highlighted significant disparity in services as well as barriers and facilitators for young people receiving a good transition to adult healthcare services.

There is ample literature on the benefits of dedicated clinics and young people friendly services supported by national standards and guidance NICE guideline [NG43], NICE Quality standard [QS140], Care Quality Commission (CQC) Transition arrangements for young people with complex health needs; however, this heightened profile is yet to translate into practice with significant variation across services in the NW. More joined up work is needed to streamline care, address specific needs and psychosocial health across kidney services in the North-West.

Aims

To set up a multi-disciplinary team network of collaboration among Paediatric and Adult Renal Units in the NW
Address variation between centres to enable more streamlined and consistent transition and young adult care by developing a policy
To be innovative and look at education support which is not routinely addressed.

Objectives

To develop a NW pathway/guideline for transition and roll this out across the region
To create an educational package for teachers to support pupils with chronic kidney disease.

The aims and objectives of this workstream is to-

Understand the current provision, pathways and expectations of renal nursing education in the NW
Explore nationally recognised educational pathways
Create a nationally recognised renal nurse pathway
Scope the current NW workforce. Gain data on:
- Dialysis Capacity – actual and potential
- ICHD nursing service provision
- Staffing levels
- Acuity of the ICHD population

To objective from these aims are to enable kidney services in the region to understand the current ICHD workforce and education pathway. Collaborate with stakeholders and other kidney organisations in the creation of a renal nurse education framework.

The creation of the NW data dashboard will demonstrate insight into the regional population demographics, demand and capacity on renal replacement services and workforce information.

Aim

The aim of the North West Kidney Networks Enhanced Supportive Kidney Care workstream is to support the delivery of quality enhanced supportive kidney care (ESKC) in North West Renal Services

Objectives

Develop regional guidance to support delivery of proactive, coordinated, and multidisciplinary ESK
- Routine supportive care needs assessment (incl. symptoms, frailty, etc)
- Addressing symptoms promptly
- Timely advance care planning discussions
- Ensuring person-centred care &, when appropriate, involvement of carers/family
- Improve end of life care
- Foster collaboration between primary and secondary care teams
Develop regional ESKC dashboard, including care quality metrics
Develop regional ESKC education and training resources
Consider regional workforce plans for ESKC provision

Aims

To co-produce a robust pathway for all NW kidney patients that will improve equitable access to genomic testing
To integrate and embed genomic testing into a renal pathway across the North-West area