Acute Kidney Injury (AKI) Education: Perceptions and Knowledge Mike Jones Acute Physician and Education Lead for Think Kidneys

Acute Kidney Injury (AKI) Education: Perceptions and Knowledge Mike Jones Acute Physician and Education Lead for Think Kidneys

Knowledge and perceptions Targeting information Tackling prejudices Promoting new knowledge

The Survey IPSOS MORI 2,005 residents of Great Britain aged 15+ questioned in their homes Participants were asked a series of questions as part of a larger omnibus survey. Included in the survey were multiple choice questions about their knowledge of human kidneys. 21.01. 3

The Questions 21.01. 4

A) Which, if any of the following things do you think your kidneys do? Make urine Remove excess fluid from the body Control the body's chemical balance Remove waste Help control blood pressure Helps keep bones healthy Help to make red blood cells Control the body s temperature Pump fluid/blood around the body Process medicines Other (specify) 21.01. 5

B) Which if any of the following do you think are the biggest dangers to the health of your kidneys? Drinking too much alcohol Dehydration Receiving a physical blow (such as a punch or a kick) to the kidneys Certain ingredients in some medicines Having a diet that is low in vitamins and minerals High cholesterol levels High blood pressure Lack of exercise Not keeping your kidneys warm Eating too much of certain vegetables (such as asparagus or beetroot) Smoking Diabetes Too much salt 21.01. 6

C) Have you heard the term Acute Kidney Injury before today or not? I have definitely heard of it I think I have heard of it No, I have not heard of it Don t know 21.01. 7

D) Which one, if any of the following, do you think best describes Acute Kidney Injury? Sudden damage to the kidneys that causes them to stop working properly as a complication of another serious illness or dehydration Sudden damage to the kidneys that causes them to stop working properly as the result of a physical blow to the kidneys Damage to the kidneys that happens over time as a result of alcohol abuse Damage to the kidneys that happens over time as a result of poor diet or lack of physical exercise Other [specify] Don t know 21.01. 8

The Findings 21.01. 9

Kidney Function Only 51% of the population know that kidneys make urine, and of those people 59% are graduates/phd know this. The older you are, the more likely you are to know kidneys make urine Only 12% of participants thought that the kidneys had a role to play in processing medicines More people believe that the kidneys help remove waste from the body (60%) than thought they made urine (51%). More people thought the kidneys made urine rather than removing excess fluid from the body 21.01. 10

Kidney Function (continued) Only a quarter (24%) thought that the kidneys helped control the body s chemical balance Nearly one in 10 participants (8%) thought the kidneys pumped blood and fluids around the body Very few participants (3%) thought they had a role in maintaining the health of bones (Table 5.1) One in 14 participants (7%) do not know what the kidneys do 21.01. 11

Dangers to kidney health Over two-thirds (68%) of the population think that too much alcohol damages kidneys You are more likely to think that alcohol causes harm to kidneys if you live in the north east or west of England, Scotland or Wales There is good understanding that dehydration can have a serious effect on your kidneys health (53%). Less than a quarter of the population (22%) think that ingredients in medicines present a problem to kidney health. Lack of exercise or poor diet are seen as more likely to cause harm by participants aged between 15 and 44, than those over 45 21.01. 12

Dangers to kidney health (continued) Only 1% of participants thought that smoking endangers the health of kidneys 35% of participants believe a physical blow endangers the health of kidneys 5% of participants did not know what endangers the health of kidneys The highest group of participants being under 34 years of age 21.01. 13

What people think are dangers to the health of kidneys, by age group 21.01. 14

What, if anything do people know about AKI? 15% of interviewees said they had definitely heard of it 16% thought they had heard of it 31% of interviewees were aware of AKI. 68% had not heard of AKI 1% didn t know whether they had heard of it Awareness of AKI is affected little by age, social grade or education Wales was the location with the highest percentage of people who had definitely heard of it at 24%. Londoners were the least likely participants to have heard of it at 9% 21.01. 15

What do people think best describes AKI? 38% said that it was due to the sudden damage to the kidneys as the result of a physical blow to the kidneys. This is almost the same as those who guessed the definition after saying they weren t aware of AKI (32%) One third of all participants (34%) think that AKI is sudden damage to the kidneys as the result of a physical blow Only one in five (21%) knew or guessed the correct definition of acute kidney injury. 21.01. 16

What do people think best describes AKI? (continued) Participants over the age of 65 are least likely to know true definition of AKI (17%) Nearly one in four (23%) thought AKI was caused by sustained alcohol abuse Of those who said they were aware of AKI, only 27% knew what it was, while the percentage that guessed and guessed correctly was 18% 21.01. 17

Changing Tack!!! Initial plan had been to tackle issues of medication and promoting advanced self care Poll results changed perspective Simple messages to promote better awareness of health promotion Understanding what the public know about their kidneys and what they do 21.01.

[Almost] everything you need to know about your kidneys What do your kidneys do? How to keep your kidneys healthy Make urine Lead a healthy lifestyle Regulate salt and ateri yourbody, making about 3-4 pints of urine each day Remove waste products from your blood into your urine Keep hydrated Don t smoke Produce hormones Keep your weight down Exercise regularly Regulate your blood pressure Create er ythropoietin to control the production of red blood cells Clean your blood Activate Vitamin D Eat a healthy diet including fresh fruit,vegetab es a dfish Reduce your intake ofsa t,processed foods and high sugar drinks Keep bones healthy Remove many drugs that some people take for other conditions If you take regular medication ask c yourpharmacistho itmayaffe t your kidneys Most people have two kidneys They are about the size o f yo u r c e ch e d fis t,th e y e ach weigh around 150g and are shaped like kidney beans They sit in your lower back under the t bottom ribs Only 50% of the population know that kidneys produce urine T h ey fi er yo u r b oo d every minute of the day Your blood goes through the kidneys 40 times in 24 hours. There are 140 miles of tubes and a million fi ters i yo u r kid eys They are the hardest working organs in your body They use 25% of the blood from every heartbeat Kidney disease has many causes and consequences. The most common recognised cause is diabetes and there is a strong link with high blood pressure. If you are worried Understanding what the public know about their kidneys and what they do about your kidneys speak to your pharmacist, GP or practice nurse. Kidney disease is serious. It s harmful and changes lives. Protect your kidneys as if your life depended on it: because it does! Find out how to keep your kidneys healthy and safe www.thinkkidneys.nhs.uk You can become a donor and help save a life by signing up at: www.organdonation.nhs.uk Your kidneys are amazing. They work so hard for you. Look after them and Think Kidneys

Your kidneysareamazing They filter your blood 40 times a day through 140 miles of tubes and a million fi lters. They produce 1.5 litres of urine a day to get rid of toxins and waste products from your body. You can help your kidneys to work better by staying hydrated. Visit w w w.t hink k idneys.nhs.uk Or talk to your GP or pharmacist to find out more

Areyou taking thepi s? Do you know how hard your kidneys work? They use a quarter of your energy to remove toxins and make urine. And they have to work even harder if you don t drink enough to stay hydrated. It s no laughing matter. Find out more about keeping them healthy at thinkkidneys.nhs.uk or nhschoices.nhs.uk Visit w w w.t hink k idneys.nhs.uk Or talk to your GP or pharmacist to find out more

Challenges Offended Retired major from Wigan Professional: BMJ contributor

BMJ Margaret McCartney: Hydration, common sense, and evidence BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4642 Concerns: Concentration of urine and sick day rules Asserts that the kidneys can concentrate urine as required ignoring the facts that damaged kidneys lose ability to completely concentrate and that there is an obligate urinary excretion rate. Talks about concentrated urine in doctors and ignores evidence that minimal dehydration can impair cognition Sick day rules NHS Highland give advice to stop ACEI/ARB/NSAIDs/diuretics when unwell Think Kidneys statement: https://www.thinkkidneys.nhs.uk/aki/wpcontent/uploads/sites/2/2015/07/t

Challenges Offended Retired major from Wigan Professional: BMJ contributor Legacy and update: Think Kidneys website Reviewing information: ACEI/ARB in AKI/heart failure Charlie Tomson/Paul Kalra

The professions Review of undergraduate curricula: Nursing, Pharmacy, Medical Postgraduate: Colleges RCP/RCGP/RCS Engagement with HEE Care Home Work Consensus statements about various aspects of AKI Think Kidneys website

?New? information ACEI/ARB are NOT nephrotoxic Use in CKD, diabetes etc Stopping ACEI/ARB in setting of heart failure and AKI may be detrimental Such patients need senior assessment of fluid balance/ intravascular volume to determine the best therapeutic regime https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2017/10/c...

Summary 1992 (first appointment as consultant) ARF not requiring dialysis - minor problem 2005 Stage 1 AKI associated with increased 4X risk of mortality 500,000 cases of AKI per year in NHS England We are still learning and we must ensure that we use the evidence that is available to promote better understanding both for the public and indeed for the professions