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Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation
  1. Tom Blakeman1,
  2. Kathryn Griffith2,
  3. Dan Lasserson3,
  4. Berenice Lopez4,
  5. Jung Y Tsang1,
  6. Stephen Campbell5,
  7. Charles Tomson6
  1. 1National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
  2. 2RCGP Clinical champion for Kidney Care, Royal College of General Practitioners, London, UK
  3. 3Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4Department of Clinical Biochemistry, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
  5. 5NIHR Greater Manchester Primary Care Patient Safety, Translational Research Centre, Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, UK
  6. 6Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  1. Correspondence to Dr Tom Blakeman; tom.blakeman{at}


Objectives Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care.

Design An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method.

Setting Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result.

Participants A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and ‘overdiagnosis’.

Results There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia.

Conclusions The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs.

  • Appropriateness
  • Acute Kidney Injury
  • Minimally Disruptive Medicine
  • Quality of Healthcare

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  • Twitter Follow Tom Blakeman at @TomBlakeman

  • Contributors TB, CT and SC designed the study. TB, KG, DL, BL, SC and CT developed the clinical scenarios for appropriateness rating and organised panel membership for round 1 and 2 ratings. SC, CT and TB conducted the round 2 meeting. TB, JYT and CT conducted the analysis and SC provided methodological expertise. All authors contributed to the interpretation of the results, commented on draft manuscripts and have given their approval for publication.

  • Funding This work was supported by Think Kidneys. Think Kidneys is a national programme led by NHS England in partnership with UK Renal Registry.

  • Disclaimer The views expressed in this document are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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