A multinational observational study exploring adherence with the kidney disease: Improving global outcomes recommendations for prevention of acute kidney injury after cardiac surgery: Anesthesia and Analgesia

M. Küllmar, R. Weiß, M. Ostermann, S. Campos, N.G. Novellas, G. Thomson, M. Haffner, C. Arndt, H. Wulf, M. Irqsusi, F. Monaco, A.L. Di Prima, M. García-Alvarez, S. Italiano, M.F. Correoso, G. Kunst, S. Nair, C. L'Acqua, E. Hoste, W. VandenbergheP.M. Honore, J.A. Kellum, L. Forni, P. Grieshaber, C. Wempe, M. Meersch, A. Zarbock

Research output: Contribution to journalArticlepeer-review

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. Copyright © 2020 International Anesthesia Research Society.
Original languageEnglish
Pages (from-to)910-916
Number of pages7
JournalAnesth. Analg.
Volume130
Issue number4
DOIs
Publication statusPublished - 2020

Keywords

  • contrast medium
  • creatinine
  • acute kidney failure
  • Article
  • clinical practice
  • controlled study
  • creatinine blood level
  • female
  • heart surgery
  • hemodynamic monitoring
  • hemodynamic parameters
  • high risk patient
  • human
  • hyperglycemia
  • major clinical study
  • male
  • managed care
  • multicenter study
  • nephrotoxicity
  • observational study
  • outcome assessment
  • phase 2 clinical trial
  • postoperative care
  • postoperative complication
  • practice guideline
  • prevalence
  • primary prevention
  • priority journal
  • protocol compliance
  • randomized controlled trial
  • treatment withdrawal
  • urine volume
  • acute lung injury
  • adult
  • aged
  • blood
  • clinical trial
  • cohort analysis
  • complication
  • incidence
  • kidney disease
  • kidney function test
  • length of stay
  • middle aged
  • physiologic monitoring
  • procedures
  • prospective study
  • urine
  • Acute Lung Injury
  • Adult
  • Aged
  • Cardiac Surgical Procedures
  • Cohort Studies
  • Creatinine
  • Female
  • Guideline Adherence
  • Humans
  • Incidence
  • Kidney Diseases
  • Kidney Function Tests
  • Length of Stay
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Postoperative Complications
  • Prevalence
  • Prospective Studies

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