1. RenalGuard –The
kidneys are nowhere
near the heart !
Paul Stephenson
What’s all the fuss about ??

2. Harvard Business Review “Providers must lead the way in
making ‘value’ the overarching goal” . – M Porter HBR Oct 2013.
where Value Based Health Care is defined as:-
Outcomes that matter to a patient
Cost of Delivery
There are two aspects for any company to solve:
FINANCIAL BENEFIT - NHS Corporate want to be able to
know and see a Return on Investment (ROI)
QUALITY & CLINICAL BENEFIT – As CCG’s are redesigning
services due to cost pressure and austerity management –
they want waste out of the budget, without a drop in
quality

3. NICE Costing Statement (Acute Kidney Injury: prevention , detection &
management of AKI up to the point of renal replacement therapy –
August 2013 (CG169)
“ 3:1 – Prevention or earlier detection and treatment of AKI is
expected to result in significantly decreased costs related to
treatment of associated complications……It is estimated that people
with AKI stay in hospital an average of 4.7 days longer than the
people of the same age in the same HRG without AKI.(4) The cost of
stay depends on the speciality in which the person is treated, and
the Payment by results tariff the spell is coded to. E.g each day’s
stay in Intensive Care Unit costs an average of £1189.(5)
4: Kerr M, Insight Health Economics (2012) – Economics of AKI
5: Hospital Episode statistics data (2012/13)

5. RenalGuard in Clinical Use

6. RenalGuard in Clinical Use

7. CTO: STATE OF THE ART Managing Complications
Dr Colm Hanratty Belfast Health and Social Care Trust
76 year old graft failure, DM, Poor EF, CHF
Diagnostic angio 150 mls CTO PCI 360 mls
50% increase Cr (no protection) with Renal Guard
7/11(pre) 13/11 (post)
Na 140 135
K 4.2 6.0
Ur 7.5 8.2
Cr 105 158
eGFR 60 37
18/01(pre) 21/01 (post)
Na 138 141
K 4.2 3.7
Ur 4.5 5.4
Cr 101 107
eGFR 62 58

9. How can RenalGuard help the Cardiologist?
It can help in procedures where there large volumes
of Contrast are used, and there is concern in
damaging nephrons.
• Long Complex CTO’s
• TAVI Diagnostic shots prior to main procedure –
remember most of these patients have poor
renal function
• Looking for the Ostia in Graft procedures
• Patients with low eGFR under 60 (as per BCIS
Guidelines )
• Patients with high Serum Creatinine levels (300+)
that need PCI, but don’t want to put them into
kidney dialysis - Hospital based haemodialysis
costs £35,000 pa per patient.

10. CI-AKI and Long-Term Outcomes

11. 3: SAFETY
Additional training for
Cath Lab Staff / Ward
staff and physicians
Savings in
overnight bed stay
Innovative new
technology attracts
CQUIN / CNST etc
Protocols for new procedure
need to be created
IPROVEMENT
IN PATIENT
OUTCOMES –
POSITIVE
PUBLICITY !

12. Start: Aquilant make
Case for a specific
product with Acute
Hospital
CCG approve ‘idea’ & Outline
Business Plan – Clinical
Advocate then prepares FULL
BUSINESS PLAN to represent
to CCG for final sanction &
coding.
Hospital buy into
‘concept’, and
wish to progress
with ‘idea’
Is Hospital a
Foundation
Trust ? (FT)
YES
Hospital is FT,
therefore as they
manage their own
budgets, can buy
without going to
the Clinical
Commissioning
Group (CCG)for
approval.
Clinical
Advocate from
Hospital,
presents
Outline
Business Case
to CCG to
change current
practise
o NB: Important to align any
proposal with local or
National Strategic Policies
to add weight to
argument.
• NB: Important to align any
FULL BUSINESS PLAN with
Hospital Quality & Safety
Plans