Responses

Download PDFPDF

What insights do patients and caregivers have on acute kidney injury and posthospitalisation care? A single-centre qualitative study from Toronto, Canada
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    More qualitative research needed to determine physician perceptions on AKI
    • Samuel A Silver, Nephrologist Queen's University, Kingston, Ontario, Canada

    Dear Editor,

    We agree with Shah et al. that caring for patients with acute kidney injury (AKI) is complicated, particularly when it comes to medication management (1). It is important to remember that AKI is a heterogenous condition with multiple etiologies and different degrees of severity. In some cases then, prioritization of other chronic diseases over AKI may be reasonable and even beneficial for patients.

    On this background, we would caution against the conclusion that physicians view AKI as a low priority concern. More qualitative research is needed first to understand physician experiences with AKI during both the inpatient and outpatient setting. This information is necessary to develop and support the use of quality improvement tools for patients with AKI, such as the medication checklists referenced by Shah et al (2).

    References:
    1. Phipps DL, Morris RL, Blakeman T, Ashcroft DM. What is involved in medicines management across care boundaries? A qualitative study of healthcare practitioners' experiences in the case of acute kidney injury. BMJ Open 2017;7:e011765.

    2. Griffith K, Ashley C, Blakeman T, Fluck R, Lewington A, Selby N, et al. ‘Sick day’ guidance in patients at risk of Acute Kidney Injury: An Interim Position Statement from the Think Kidneys Board 2015.

    Conflict of Interest:
    None declared.
  • Published on:
    Further insights into Acute Kidney Injury
    • Pooja Shah, Medical Student Imperial College London
    • Other Contributors:
      • Padmanabh Bhatt, Medical Student
      • Gautham Benoy, medical student
      • Shubham Gupta, Medical student
      • Kanishk Jain, Medical student

    Dear Editor,

    We have read with great interest the article “What insights do patients and caregivers have on acute kidney injury and post-hospitalisation care? A single-center qualitative study from Toronto, Canada” by Silver et al.

    The article sheds light on the fact that most of its participants prioritised chronic conditions that ‘progress over time’ over AKI. These co-morbidities often include heart failure, hypertension and Type 2 diabetes mellitus, which are treated with non-steroidal anti-inflammatory drugs, diuretics and metformin respectively( 1). There is considerable data that these drugs are nephrotoxic and should therefore, be deprescribed or temporarily with-held or dose-adjusted in patients with AKI.

    However, from unpublished research at our hospital, there is often reluctance to stop these drugs, suggesting that this misconception may be shared by physicians as well. As this is a common clinical problem with considerable morbidity, Think Kidneys Campaign (NHS collaboration of various trusts) have developed a checklist for medication optimization in patients with AKI (2), but its use is sparse at least from our experience.

    Studies have shown that in-hospital mortality due to AKI far exceeds that due to these long-standing, chronic conditions. In a large nation-based study, in-hospital mortality of AKI was found to be 12.32% (3), with an increase in number of absolute deaths from 2001 to 2011. This is in contrast to the 3% in-...

    Show More
    Conflict of Interest:
    None declared.