Prevention of Cardiac Surgery-Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial.

Autor:	Zarbock A; From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany., Küllmar M; From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany., Ostermann M; Department of Critical Care, Guy's & St Thomas' National Health Service Foundation Hospital, London, United Kingdom., Lucchese G; Department of Critical Care, Guy's & St Thomas' National Health Service Foundation Hospital, London, United Kingdom., Baig K; Department of Critical Care, Guy's & St Thomas' National Health Service Foundation Hospital, London, United Kingdom., Cennamo A; Department of Critical Care, Guy's & St Thomas' National Health Service Foundation Hospital, London, United Kingdom., Rajani R; Department of Critical Care, Guy's & St Thomas' National Health Service Foundation Hospital, London, United Kingdom., McCorkell S; Department of Critical Care, Guy's & St Thomas' National Health Service Foundation Hospital, London, United Kingdom., Arndt C; Department of Anesthesiology and Intensive Care Medicine., Wulf H; Department of Anesthesiology and Intensive Care Medicine., Irqsusi M; Department of Cardiac Surgery, University Hospital Marburg, Marburg, Germany., Monaco F; Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy., Di Prima AL; Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy., García Alvarez M; Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Italiano S; Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Miralles Bagan J; Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Kunst G; Department of Anesthetics, King's College Hospital, Denmark Hill, London, United Kingdom., Nair S; Department of Anesthetics, King's College Hospital, Denmark Hill, London, United Kingdom., L'Acqua C; Department of Anesthesia and Critical Care, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy., Hoste E; Department of Intensive Care Medicine, University Hospital Gent, Gent, Belgium., Vandenberghe W; Department of Intensive Care Medicine, University Hospital Gent, Gent, Belgium., Honore PM; Department of Intensive Care, CHU Brugmann University Hospital, Brussels, Belgium., Kellum JA; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania., Forni LG; Department of Intensive Care Medicine, Royal Surrey County Hospital & Faculty of Health Sciences, University of Surrey, Guildford, United Kingdom., Grieshaber P; Department of Cardiac Surgery, University Hospital Giessen, Giessen, Germany., Massoth C; From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany., Weiss R; From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany., Gerss J; Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany., Wempe C; From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany., Meersch M; From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2021 Aug 01; Vol. 133 (2), pp. 292-302.
DOI:	10.1213/ANE.0000000000005458
Abstrakt:	Background: Prospective, single-center trials have shown that the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations in high-risk patients significantly reduced the development of acute kidney injury (AKI) after surgery. We sought to evaluate the feasibility of implementing a bundle of supportive measures based on the KDIGO guideline in high-risk patients undergoing cardiac surgery in a multicenter setting in preparation for a large definitive trial. Methods: In this multicenter, multinational, randomized controlled trial, we examined the adherence to the KDIGO bundle consisting of optimization of volume status and hemodynamics, functional hemodynamic monitoring, avoidance of nephrotoxic drugs, and prevention of hyperglycemia in high-risk patients identified by the urinary biomarkers tissue inhibitor of metalloproteinases-2 [TIMP-2] and insulin growth factor-binding protein 7 [IGFBP7] after cardiac surgery. The primary end point was the adherence to the bundle protocol and was evaluated by the percentage of compliant patients with a 95% confidence interval (CI) according to Clopper-Pearson. Secondary end points included the development and severity of AKI. Results: In total, 278 patients were included in the final analysis. In the intervention group, 65.4% of patients received the complete bundle as compared to 4.2% in the control group (absolute risk reduction [ARR] 61.2 [95% CI, 52.6-69.9]; P < .001). AKI rates were statistically not different in both groups (46.3% intervention versus 41.5% control group; ARR -4.8% [95% CI, -16.4 to 6.9]; P = .423). However, the occurrence of moderate and severe AKI was significantly lower in the intervention group as compared to the control group (14.0% vs 23.9%; ARR 10.0% [95% CI, 0.9-19.1]; P = .034). There were no significant effects on other specified secondary outcomes. Conclusions: Implementation of a KDIGO-derived treatment bundle is feasible in a multinational setting. Furthermore, moderate to severe AKI was significantly reduced in the intervention group. Competing Interests: Conflicts of Interest: See Disclosures at the end of the article. (Copyright © 2021 International Anesthesia Research Society.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu