Act faster for your chronic kidney disease patients.

Since the time Louis Vincent invented the concept of FAST HUG,[1] there has been a huge impetus provided in the management of critically ill patients. It has also seen a rise in the extension of the mnemonic to FAST HUG BID[2] and others, which has definitely provided a quick way to screen critically ill patients in the busy wards.

With the advent of better diagnostic modalities and better understanding of renal physiology over the years, there has been a growing need to look at all the aspects of patient care in the management of chronic kidney patients presenting to the nephrologist. In the process, there may be cases where priority may be given to only certain aspects of care.

We introduce a mnemonic called ACT FASTER that would enable the treating unit to look at all the aspects of patient care. The mnemonic allows identification of key aspects of the care of all chronic kidney disease (CKD) patients, especially those in Stage 5. It can be used during ward rounds, and may go a long way in the general management of our cases.

A: Anemia status; hemoglobin, transferrin saturation, ferritin, and other relevant reports.

Review of erythropoietin and iron doses.

C: Calcium, phosphorus, Vitamin D level, iPTH levels, and mineral bone disease status.

Adjustment of medications.

T: Treatment review, drug dose adjustments if needed.

F: Food and nutrition review. May involve dietitian feedback.

A: Access creation and current access status with any complications.

S: Serology status (if on hemodialysis [HD]) and vaccination status.

T: Treatment of other co-morbid conditions such as diabetes mellitus and hypertension.

Review of medications for optimization of control.

E: Exclusion of reversible factors if suspected.

(e.g., prerenal causes, postrenal causes, nephrotoxics, myeloma, vasculitis, etc.).

R: Renal size and echotexture, other relevant renal imaging results.

Renal biopsy report review, if available.

Application of this simple strategy will encourage teamwork and may help improve the quality of care received by CKD patients. Further studies including a big cohort of patients can be undertaken to look into the impact of such strategy and its utility for patient management.