A Multinational Observational Study Exploring Adherence With the Kidney Disease: Improving Global Outcomes Recommendations for Prevention of Acute Kidney Injury After Cardiac Surgery

Mira Küllmar, Raphael Weiß, Marlies Ostermann, Sara Campos, Neus Grau Novellas, Gary Thomson, Michael Haffner, Christian Arndt, Hinnerk Wulf, Marc Irqsusi, Fabrizio Monaco, Ambra Licia Di Prima, Mercedes García-Alvarez, Stefano Italiano, Mar Felipe Correoso, Gudrun Kunst, Shrijit Nair, Camilla L'Acqua, Eric Hoste, Wim VandenberghePatrick M Honore, John A Kellum, Lui Forni, Philippe Grieshaber, Carola Wempe, Melanie Meersch, Alexander Zarbock

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)910-916
Number of pages7
JournalAnesthesia and Analgesia
Volume130
Issue number4
DOIs
Publication statusPublished - Apr 2020

Keywords

  • Acute Lung Injury/epidemiology
  • Adult
  • Aged
  • Cardiac Surgical Procedures/methods
  • Cohort Studies
  • Creatinine/blood
  • Female
  • Guideline Adherence/statistics & numerical data
  • Humans
  • Incidence
  • Kidney Diseases/complications
  • Kidney Function Tests
  • Length of Stay
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Postoperative Complications/prevention & control
  • Prevalence
  • Prospective Studies

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