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C Gibbons, H Alexander, 2782 Don’t panic! How acute kidney injury and hyponatraemia can be safely managed on a frailty virtual Ward, Age and Ageing, Volume 54, Issue Supplement_1, January 2025, afae277.011, https://doi.org/10.1093/ageing/afae277.011
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Abstract
Acute kidney injury (AKI) and hyponatraemia are common causes for hospital admission for frail, elderly people. Some patients could be managed at home using the Virtual Ward model, reducing risk of healthcare related adverse events. We aimed to show plausibility for this treatment model.
We produced guidance for managing patients with AKI/hyponatraemia on the Frailty Virtual Ward (FVW). We then collected data from patients treated for AKI (N = 12) and hyponatraemia (sodium <126 mmol/L) (N = 9) and compared with a similar inpatient cohort (AKI N = 14, hyponatraemia N = 16). FVW patients received remote vital signs monitoring, telephone consultations and blood tests.
AKI: FVW patients had creatinine rise 30–101%, and pre-renal AKI. They had fewer adverse events and none died. None required intravenous therapy or Renal input. Most fully recovered by discharge, whilst some established a new creatinine baseline, and had community follow-up. Inpatients had more severe AKI and frailty contributing to higher mortality and adverse events. Hyponatraemia: FVW patients had asymptomatic/chronic moderately-severe hyponatraemia (sodium 120-126 mmol/L). The most common cause was SIADH. They were less likely to undergo hyponatraemia investigations, but more likely to receive an explanation for hyponatraemia. They had fewer healthcare associated adverse events, readmissions, or deaths. Inpatients were more severely unwell. Three FVW patients received Endocrine opinions. Most FWV patients recovered (sodium >125 mmol/L), except one who was admitted (sodium 120 mmol/L) and one who had a follow-up plan for sodium 124 mmol/L.
Mild AKI and moderately severe chronic/asymptomatic hyponatraemia can be managed under the Frailty Virtual Ward model with few adverse events compared with inpatient care. Underlying causes often require minimal medical intervention, such as medication review or fluid restriction. Specialist input is still possible. Work is needed to ensure FVW patients receive the same level of investigation as inpatients, and that they have a clear follow-up plan.
- consultation
- hyponatremia
- blood tests
- creatinine
- renal failure, acute
- frailty
- follow-up
- frail elderly
- inappropriate adh syndrome
- inpatients
- panic
- patient readmission
- patients' rooms
- telephone
- kidney
- mortality
- sodium
- vital signs
- risk reduction
- therapeutic intervention
- hospital admission
- community
- adverse event
- medication review
- fluid restriction
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