Mira Küllmar1, Raphael Weiß1, Marlies Ostermann2, Sara Campos2, Neus Grau Novellas2, Gary Thomson2, Michael Haffner2, Christian Arndt3, Hinnerk Wulf3, Marc Irqsusi4, Fabrizio Monaco5, Ambra Licia Di Prima5, Mercedes García-Alvarez6, Stefano Italiano6, Mar Felipe Correoso6, Gudrun Kunst7, Shrijit Nair7, Camilla L'Acqua8, Eric Hoste9, Wim Vandenberghe9, Patrick M Honore10, John A Kellum11, Lui Forni12, Philippe Grieshaber13, Carola Wempe1, Melanie Meersch1, Alexander Zarbock1. 1. From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany. 2. Department of Critical Care, Guy's & St Thomas' NHS Foundation Hospital, London, United Kingdom. 3. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany. 4. Department of Cardiac Surgery, University Hospital Marburg, Marburg, Germany. 5. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 7. Department of Anaesthetics, King's College Hospital, Denmark Hill, London, United Kingdom. 8. Centro Cardiologico Monzino IRCCS, Milan, Italy. 9. Department of Intensive Care Medicine, University Hospital Gent, Gent, Belgium. 10. Department of Intensive Care, CHU Brugmann University Hospital, Brussel, Belgium. 11. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania. 12. Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, United Kingdom. 13. Department of Cardiac Surgery, University Hospital Giessen, Giessen, Germany.
Abstract
BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a bundle of different measures for patients at increased risk of acute kidney injury (AKI). Prospective, single-center, randomized controlled trials (RCTs) have shown that management in accordance with the KDIGO recommendations was associated with a significant reduction in the incidence of postoperative AKI in high-risk patients. However, compliance with the KDIGO bundle in routine clinical practice is unknown. METHODS: This observational prevalence study was performed in conjunction with a prospective RCT investigating the role of the KDIGO bundle in high-risk patients undergoing cardiac surgery. A 2-day observational prevalence study was performed in all participating centers before the RCT to explore routine clinical practice. The participating hospitals provided the following data: demographics and surgical characteristics, AKI rates, and compliance rates with the individual components of the bundle. RESULTS: Ninety-five patients were enrolled in 12 participating hospitals. The incidence of AKI within 72 hours after cardiac surgery was 24.2%. In 5.3% of all patients, clinical management was fully compliant with all 6 components of the bundle. Nephrotoxic drugs were discontinued in 52.6% of patients, volume optimization was performed in 70.5%, 52.6% of the patients underwent functional hemodynamic monitoring, close monitoring of serum creatinine and urine output was undertaken in 24.2% of patients, hyperglycemia was avoided in 41.1% of patients, and no patient received radiocontrast agents. The patients received on average 3.4 (standard deviation [SD] ±1.1) of 6 supportive measures as recommended by the KDIGO guidelines. There was no significant difference in the number of applied measures between AKI and non-AKI patients (3.2 [SD ±1.1] vs 3.5 [SD ±1.1]; P = .347). CONCLUSIONS: In patients after cardiac surgery, compliance with the KDIGO recommendations was low in routine clinical practice.
BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a bundle of different measures for patients at increased risk of acute kidney injury (AKI). Prospective, single-center, randomized controlled trials (RCTs) have shown that management in accordance with the KDIGO recommendations was associated with a significant reduction in the incidence of postoperative AKI in high-risk patients. However, compliance with the KDIGO bundle in routine clinical practice is unknown. METHODS: This observational prevalence study was performed in conjunction with a prospective RCT investigating the role of the KDIGO bundle in high-risk patients undergoing cardiac surgery. A 2-day observational prevalence study was performed in all participating centers before the RCT to explore routine clinical practice. The participating hospitals provided the following data: demographics and surgical characteristics, AKI rates, and compliance rates with the individual components of the bundle. RESULTS: Ninety-five patients were enrolled in 12 participating hospitals. The incidence of AKI within 72 hours after cardiac surgery was 24.2%. In 5.3% of all patients, clinical management was fully compliant with all 6 components of the bundle. Nephrotoxic drugs were discontinued in 52.6% of patients, volume optimization was performed in 70.5%, 52.6% of the patients underwent functional hemodynamic monitoring, close monitoring of serum creatinine and urine output was undertaken in 24.2% of patients, hyperglycemia was avoided in 41.1% of patients, and no patient received radiocontrast agents. The patients received on average 3.4 (standard deviation [SD] ±1.1) of 6 supportive measures as recommended by the KDIGO guidelines. There was no significant difference in the number of applied measures between AKI and non-AKIpatients (3.2 [SD ±1.1] vs 3.5 [SD ±1.1]; P = .347). CONCLUSIONS: In patients after cardiac surgery, compliance with the KDIGO recommendations was low in routine clinical practice.
Authors: Jay L Koyner; Lakhmir S Chawla; Azra Bihorac; Kyle J Gunnerson; Rebecca Schroeder; Sevag Demirjian; Luke Hodgson; Jennifer A Frey; Scott T Wilber; J Patrick Kampf; Thomas Kwan; Paul McPherson; John A Kellum Journal: Kidney360 Date: 2022-03-24
Authors: Andrew D Shaw; Nicole R Guinn; Jessica K Brown; Rakesh C Arora; Kevin W Lobdell; Michael C Grant; Tong J Gan; Daniel T Engelman Journal: Perioper Med (Lond) Date: 2022-04-28
Authors: Dennis G Moledina; Olivia Belliveau; Yu Yamamoto; Tanima Arora; Kyle A Carey; Matthew Churpek; Melissa Martin; Caitlin M Partridge; Sherry G Mansour; Chirag R Parikh; Jay L Koyner; F Perry Wilson Journal: Am J Kidney Dis Date: 2020-10-17 Impact factor: 8.860