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Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial
- Source :
- Intensive care medicine. 43(11)
- Publication Year :
- 2016
-
Abstract
- Care bundles are recommended in patients at high risk for acute kidney injury (AKI), although they have not been proven to improve outcomes. We sought to establish the efficacy of an implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guidelines to prevent cardiac surgery-associated AKI in high risk patients defined by renal biomarkers.In this single-center trial, we examined the effect of a "KDIGO bundle" consisting of optimization of volume status and hemodynamics, avoidance of nephrotoxic drugs, and preventing hyperglycemia in high risk patients defined as urinary [TIMP-2]·[IGFBP7] 0.3 undergoing cardiac surgery. The primary endpoint was the rate of AKI defined by KDIGO criteria within the first 72 h after surgery. Secondary endpoints included AKI severity, need for dialysis, length of stay, and major adverse kidney events (MAKE) at days 30, 60, and 90.AKI was significantly reduced with the intervention compared to controls [55.1 vs. 71.7%; ARR 16.6% (95 CI 5.5-27.9%); p = 0.004]. The implementation of the bundle resulted in significantly improved hemodynamic parameters at different time points (p 0.05), less hyperglycemia (p 0.001) and use of ACEi/ARBs (p 0.001) compared to controls. Rates of moderate to severe AKI were also significantly reduced by the intervention compared to controls. There were no significant effects on other secondary outcomes.An implementation of the KDIGO guidelines compared with standard care reduced the frequency and severity of AKI after cardiac surgery in high risk patients. Adequately powered multicenter trials are warranted to examine mortality and long-term renal outcomes.
- Subjects :
- Male
medicine.medical_specialty
Organ Dysfunction Scores
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
urologic and male genital diseases
Critical Care and Intensive Care Medicine
Severity of Illness Index
Statistics, Nonparametric
law.invention
03 medical and health sciences
chemistry.chemical_compound
Angiotensin Receptor Antagonists
0302 clinical medicine
Postoperative Complications
Randomized controlled trial
law
Risk Factors
Anesthesiology
Severity of illness
medicine
Humans
Intensive care medicine
Aged
Creatinine
Tissue Inhibitor of Metalloproteinase-2
High risk patients
Cardiopulmonary Bypass
urogenital system
business.industry
Hemodynamic Monitoring
Acute kidney injury
030208 emergency & critical care medicine
Acute Kidney Injury
Length of Stay
Middle Aged
medicine.disease
Cardiac surgery
Insulin-Like Growth Factor Binding Proteins
chemistry
Practice Guidelines as Topic
Female
business
Biomarkers
Echocardiography, Transesophageal
Kidney disease
Subjects
Details
- ISSN :
- 14321238
- Volume :
- 43
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Intensive care medicine
- Accession number :
- edsair.doi.dedup.....ccdd7f0f48f3576888a9cef45f067462