Renal teams supporting AKI in the critically ill patient
Review of London kidney teams’ response to COVID-19, March-June 2020
Summary of key themes
Training of ITU teams – develop shared resources and experience across London in the training and education of renal and intensive care teams to support renal replacement therapy for critically ill patients.
Consider having a named renal consultant present in ITU for peak surge periods to improve communications and support teamwork and shared learning.
Continue to share the diverse approaches across London to help meet the needs of patients with specific RRT requirements (such as PD where coagulopathy renders vascular access very difficult).
We achieved good outcomes in some kidney patients using innovative solutions. How do we evaluate these for use in the future?
Intermittent haemodialysis was an option for ongoing HD care in place of CRRT.
Kidney teams can collaborate with critical care teams to minimise risk of acute kidney injury and avoid starting renal replacement therapy sooner than is necessary or beneficial.
Next steps
Use the London Networks to develop a pan-London
ITU/Renal nurse group to support a sustainable training model to maintain
skills. Potential to involve industry in the delivery of this.
Share learning between ITU and renal networks
and ensure closer collaboration and joint planning for second surges
Collate outcome (PD, CRRT, IHD in AKI) and
histopathology data, and share analysis and findings to inform future planning
Summary of discussions
What worked well?
Collaboration between Nephrologists and
Intensivists was vital to meet the unpredicted demand for RRT on ICU
Different units found different solutions (e.g.
IHD, APD, making fluids for CVVHD) all of which had merit and drawbacks
The practical expertise of the technicians was
vital in planning and delivering and expanding RRT at pace in ICU. The use of
portable RO units was an essential part of this
Sector level critical care and renal
collaborations were vital for active movement of patients and provision of care
Pan London collection of data and sharing of
wider information was also essential, not least to allow the movement of
patients between sectors when needed
Local efforts by renal teams to establish
alternatives to filtration within their own trusts were essential
Accelerated training nursing plans in working
with ITU colleagues enabled teams to deliver IHD
ITU teams found that having a named renal
consultant shared learning and improved communication and teamwork
There was fantastic work from Renal technicians
to get necessary work done to facilitate RRT expansion
Key challenges
Working at such a pace for a sustained period
was challenging
There were different levels of network
functioning and functional groups depending on purpose: clarity on each of
these roles only emerged after some weeks and with some avoidable duplication
of effort
Managing the practicalities of installing water,
rapidly expanding PD, sustaining workforce, and providing training
Burden on staff, especially dialysis nurses, to
provide renal support in ITU whilst also maintaining staffing for ICHD units
What could we do better?
Improve decision-making and communication with
patients and families regarding treatment escalation plans
Capitalise on the opportunity to continue the
improved management of AKI through structured and ongoing closer collaboration
between renal and ITU teams
Clearer transfer protocols covering escalation
of patients in non-renal centres
