BACKGROUND: Early detection and prevention of acute kidney injury (AKI) is important to reduce morbidity and mortality. Discovery of early-detection biomarkers has enabled early preventive approaches. There are no data on early biomarker-guided intervention with nephrological consultation in emergency departments (EDs). METHODS: In this prospective randomized controlled intervention trial, patients at high risk for AKI were screened with urinary [TIMP-2]·[IGFBP7] in the ED of Robert-Bosch-Hospital (Stuttgart, Germany). We screened 257 eligible patients of whom 100 met the inclusion criteria, with urinary [TIMP-2]·[IGFBP7] >0.3, and were included. The intervention group received immediate one-time nephrological consultation after randomization, implementing Kidney Disease: Improving Global Outcomes (KDIGO) 2012 recommendations on AKI. The primary outcome was the incidence of moderate to severe AKI within the first day after admission. Secondary outcomes were AKI occurrence within 3 days after admission, need for renal replacement therapy (RRT), length of hospital stay and death. RESULTS: The primary outcome did not differ significantly (P = 0.9) between the groups, neither within the first day nor within the first 3 days after admission. The intervention group had significantly (P < 0.05) lower serum creatinine (SCr) on Day 2 and lower maximum SCr and tended (P = 0.08) to have higher urine output (UOP) at Day 3 than the non-intervention group. No patient in the intervention group needed RRT (0 versus 3) during the hospital stay (P = 0.09). CONCLUSIONS: One-time routine nephrologist-guided application of the KDIGO bundle in ED patients with a risk for AKI cannot currently be recommended. However, due to the uniform trend of study endpoints in favour of intervention, further trials to investigate larger cohorts of more severely ill patients are warranted. TRIAL REGISTRATION: www.ClinicalTrials.gov, study number NCT02730637.
RCT Entities:
BACKGROUND: Early detection and prevention of acute kidney injury (AKI) is important to reduce morbidity and mortality. Discovery of early-detection biomarkers has enabled early preventive approaches. There are no data on early biomarker-guided intervention with nephrological consultation in emergency departments (EDs). METHODS: In this prospective randomized controlled intervention trial, patients at high risk for AKI were screened with urinary [TIMP-2]·[IGFBP7] in the ED of Robert-Bosch-Hospital (Stuttgart, Germany). We screened 257 eligible patients of whom 100 met the inclusion criteria, with urinary [TIMP-2]·[IGFBP7] >0.3, and were included. The intervention group received immediate one-time nephrological consultation after randomization, implementing Kidney Disease: Improving Global Outcomes (KDIGO) 2012 recommendations on AKI. The primary outcome was the incidence of moderate to severe AKI within the first day after admission. Secondary outcomes were AKI occurrence within 3 days after admission, need for renal replacement therapy (RRT), length of hospital stay and death. RESULTS: The primary outcome did not differ significantly (P = 0.9) between the groups, neither within the first day nor within the first 3 days after admission. The intervention group had significantly (P < 0.05) lower serum creatinine (SCr) on Day 2 and lower maximum SCr and tended (P = 0.08) to have higher urine output (UOP) at Day 3 than the non-intervention group. No patient in the intervention group needed RRT (0 versus 3) during the hospital stay (P = 0.09). CONCLUSIONS: One-time routine nephrologist-guided application of the KDIGO bundle in ED patients with a risk for AKI cannot currently be recommended. However, due to the uniform trend of study endpoints in favour of intervention, further trials to investigate larger cohorts of more severely ill patients are warranted. TRIAL REGISTRATION: www.ClinicalTrials.gov, study number NCT02730637.
Authors: Etienne Macedo; Azra Bihorac; Edward D Siew; Paul M Palevsky; John A Kellum; Claudio Ronco; Ravindra L Mehta; Mitchell H Rosner; Michael Haase; Kianoush B Kashani; Erin F Barreto Journal: Eur J Intern Med Date: 2020-06-30 Impact factor: 4.487
Authors: Fiorenza Ferrari; Mariangela Valentina Puci; Ottavia Eleonora Ferraro; Gregorio Romero-González; Faeq Husain-Syed; Lilia Rizo-Topete; Mara Senzolo; Anna Lorenzin; Eva Muraro; Antonio Baracca; Mara Serrano-Soto; Alejandra Molano Triviño; Ana Coutinho Castro; Massimo De Cal; Valentina Corradi; Alessandra Brendolan; Marta Scarpa; Maria Rosa Carta; Davide Giavarina; Raffaele Bonato; Giorgio Antonio Iotti; Claudio Ronco Journal: PLoS One Date: 2019-06-20 Impact factor: 3.240
Authors: John A Kellum; Antonio Artigas; Kyle J Gunnerson; Patrick M Honore; J Patrick Kampf; Thomas Kwan; Paul McPherson; H Bryant Nguyen; Thomas Rimmelé; Nathan I Shapiro; Jing Shi; Jean-Louis Vincent; Lakhmir S Chawla Journal: Crit Care Med Date: 2021-04-01 Impact factor: 9.296
Authors: Hyun Suk Yang; Mina Hur; Kyeong Ryong Lee; Hanah Kim; Hahn Young Kim; Jong Won Kim; Mui Teng Chua; Win Sen Kuan; Horng Ruey Chua; Chagriya Kitiyakara; Phatthranit Phattharapornjaroen; Anchalee Chittamma; Thiyapha Werayachankul; Urmila Anandh; Sanjeeva Herath; Zoltan Endre; Andrea Rita Horvath; Paola Antonini; Salvatore Di Somma Journal: Ann Lab Med Date: 2022-03-01 Impact factor: 3.464
Authors: Conor Judge; Robert Murphy; Catriona Reddin; Sarah Cormican; Andrew Smyth; Martin O'Halloran; Martin J O'Donnell Journal: Kidney Med Date: 2021-08-20
Authors: Kianoush Kashani; Mitchell Howard Rosner; Michael Haase; Andrew J P Lewington; Donal J O'Donoghue; F Perry Wilson; Mitra K Nadim; Samuel A Silver; Alexander Zarbock; Marlies Ostermann; Ravindra L Mehta; Sandra L Kane-Gill; Xiaoqiang Ding; Peter Pickkers; Azra Bihorac; Edward D Siew; Erin F Barreto; Etienne Macedo; John A Kellum; Paul M Palevsky; Ashita Jiwat Tolwani; Claudio Ronco; Luis A Juncos; Oleksa G Rewa; Sean M Bagshaw; Theresa Ann Mottes; Jay L Koyner; Kathleen D Liu; Lui G Forni; Michael Heung; Vin-Cent Wu Journal: Clin J Am Soc Nephrol Date: 2019-05-17 Impact factor: 8.237