TY - JOUR
T1 - A Multinational Observational Study Exploring Adherence With the Kidney Disease
T2 - Improving Global Outcomes Recommendations for Prevention of Acute Kidney Injury After Cardiac Surgery
AU - Küllmar, Mira
AU - Weiß, Raphael
AU - Ostermann, Marlies
AU - Campos, Sara
AU - Grau Novellas, Neus
AU - Thomson, Gary
AU - Haffner, Michael
AU - Arndt, Christian
AU - Wulf, Hinnerk
AU - Irqsusi, Marc
AU - Monaco, Fabrizio
AU - Di Prima, Ambra Licia
AU - García-Alvarez, Mercedes
AU - Italiano, Stefano
AU - Felipe Correoso, Mar
AU - Kunst, Gudrun
AU - Nair, Shrijit
AU - L'Acqua, Camilla
AU - Hoste, Eric
AU - Vandenberghe, Wim
AU - Honore, Patrick M
AU - Kellum, John A
AU - Forni, Lui
AU - Grieshaber, Philippe
AU - Wempe, Carola
AU - Meersch, Melanie
AU - Zarbock, Alexander
PY - 2020/4
Y1 - 2020/4
N2 - 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.
AB - 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.
KW - Acute Lung Injury/epidemiology
KW - Adult
KW - Aged
KW - Cardiac Surgical Procedures/methods
KW - Cohort Studies
KW - Creatinine/blood
KW - Female
KW - Guideline Adherence/statistics & numerical data
KW - Humans
KW - Incidence
KW - Kidney Diseases/complications
KW - Kidney Function Tests
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Monitoring, Physiologic
KW - Postoperative Complications/prevention & control
KW - Prevalence
KW - Prospective Studies
U2 - 10.1213/ANE.0000000000004642
DO - 10.1213/ANE.0000000000004642
M3 - Article
C2 - 31922998
SN - 0003-2999
VL - 130
SP - 910
EP - 916
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 4
ER -