Ivan Göcze1, Dominik Jauch2, Markus Götz1, Pascal Kennedy1, Bettina Jung3, Florian Zeman4, Carsten Gnewuch5, Bernhard M Graf6, Wolfgang Gnann7, Bernhard Banas3, Thomas Bein6, Hans J Schlitt1, Tobias Bergler3. 1. Department of Surgery, University Hospital Regensburg, Germany. 2. Department of Surgery, University Hospital Freiburg, Germany. 3. Department of Nephrology, University Hospital Regensburg, Germany. 4. Center for Clinical Studies, University Hospital Regensburg, Germany. 5. Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany. 6. Department of Anesthesiology, University Hospital Regensburg, Germany. 7. Center for Business Development, University Hospital Regensburg, Germany.
Abstract
OBJECTIVE: To determine the impact of renal biomarker-guided implementation of the Kidney Disease Improving Global Outcomes (KDIGO) care bundle on the incidence of acute kidney injury (AKI) after major noncardiac surgery in a single-center unblinded randomized clinical trial. BACKGROUND: Early optimization of volume status and discontinuation of nephrotoxic medication before the occurrence of AKI may be the crucial step to reduce preventable AKI. METHODS: The urinary biomarker-triggered KDIGO care bundle (early optimization of fluid status, maintenance of perfusion pressure, discontinuation of nephrotoxic agents) was compared to standard intensive care unit (ICU) care in 121 patients with an increased AKI risk after major abdominal surgery that was determined by urinary biomarker (inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7) >0.3. Incidence of overall AKI, severity of AKI, length of stay, major kidney events at discharge, and cost effectiveness were evaluated. RESULTS: The overall stages of AKI were not statistically different between the 2 groups, but in patients with inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7 values of 0.3 to 2.0 a subgroup analysis demonstrated a significantly reduced incidence of AKI 13/48 (27.1%) in the intervention group compared to control 24/50 (48.0%, P = 0.03). Incidence of moderate and severe AKI (P = 0.04), incidence of creatinine increase >25% of baseline value (P = 0.01), length of ICU, and hospital stay (P = 0.04) were significantly lower in the intervention group. Intervention was associated with cost reduction. There were no significant differences regarding renal replacement therapy, in-hospital mortality, or major kidney events at hospital discharge. CONCLUSIONS: Early biomarker-based prediction of imminent AKI followed by implementation of KDIGO care bundle reduced AKI severity, postoperative creatinine increase, length of ICU, and hospital stay in patients after major noncardiac surgery.
RCT Entities:
OBJECTIVE: To determine the impact of renal biomarker-guided implementation of the Kidney Disease Improving Global Outcomes (KDIGO) care bundle on the incidence of acute kidney injury (AKI) after major noncardiac surgery in a single-center unblinded randomized clinical trial. BACKGROUND: Early optimization of volume status and discontinuation of nephrotoxic medication before the occurrence of AKI may be the crucial step to reduce preventable AKI. METHODS: The urinary biomarker-triggered KDIGO care bundle (early optimization of fluid status, maintenance of perfusion pressure, discontinuation of nephrotoxic agents) was compared to standard intensive care unit (ICU) care in 121 patients with an increased AKI risk after major abdominal surgery that was determined by urinary biomarker (inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7) >0.3. Incidence of overall AKI, severity of AKI, length of stay, major kidney events at discharge, and cost effectiveness were evaluated. RESULTS: The overall stages of AKI were not statistically different between the 2 groups, but in patients with inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7 values of 0.3 to 2.0 a subgroup analysis demonstrated a significantly reduced incidence of AKI 13/48 (27.1%) in the intervention group compared to control 24/50 (48.0%, P = 0.03). Incidence of moderate and severe AKI (P = 0.04), incidence of creatinine increase >25% of baseline value (P = 0.01), length of ICU, and hospital stay (P = 0.04) were significantly lower in the intervention group. Intervention was associated with cost reduction. There were no significant differences regarding renal replacement therapy, in-hospital mortality, or major kidney events at hospital discharge. CONCLUSIONS: Early biomarker-based prediction of imminent AKI followed by implementation of KDIGO care bundle reduced AKI severity, postoperative creatinine increase, length of ICU, and hospital stay in patients after major noncardiac surgery.
Authors: Phillip S Adams; Diana Vargas; Tracy Baust; Lucas Saenz; Wonshill Koh; Brian Blasiole; Patrick M Callahan; Aparna S Phadke; Khoa N Nguyen; Yuliya Domnina; Mahesh Sharma; John A Kellum; Joan Sanchez-de-Toledo Journal: Pediatr Crit Care Med Date: 2019-01 Impact factor: 3.624
Authors: Sehoon Park; Hyunjeong Cho; Seokwoo Park; Soojin Lee; Kwangsoo Kim; Hyung Jin Yoon; Jiwon Park; Yunhee Choi; Suehyun Lee; Ju Han Kim; Sejoong Kim; Ho Jun Chin; Dong Ki Kim; Kwon Wook Joo; Yon Su Kim; Hajeong Lee Journal: J Am Soc Nephrol Date: 2018-12-18 Impact factor: 10.121
Authors: M Joannidis; S J Klein; S John; M Schmitz; D Czock; W Druml; A Jörres; D Kindgen-Milles; J T Kielstein; M Oppert; V Schwenger; C Willam; A Zarbock Journal: Med Klin Intensivmed Notfmed Date: 2018-03-28 Impact factor: 0.840