Real-Time Acute Kidney Injury Risk Stratification-Biomarker Directed Fluid Management Improves Outcomes in Critically Ill Children and Young Adults.
| Autor: | Goldstein SL; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Krallman KA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Roy JP; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Collins M; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Chima RS; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Basu RK; Lurie Children's Hospital, Chicago Illinois, USA., Chawla L; Department of Veteran's Affairs, Washington, DC, USA., Fei L; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Kidney international reports [Kidney Int Rep] 2023 Sep 22; Vol. 8 (12), pp. 2690-2700. Date of Electronic Publication: 2023 Sep 22 (Print Publication: 2023). |
| DOI: | 10.1016/j.ekir.2023.09.019 |
| Abstrakt: | Introduction: Critically ill admitted patients are at high risk of acute kidney injury (AKI). The renal angina index (RAI) and urinary biomarker neutrophil gelatinase-associated lipocalin (uNGAL) can aid in AKI risk assessment. We implemented the Trial in AKI using NGAL and Fluid Overload to optimize CRRT Use (TAKING FOCUS 2; TF2) to personalize fluid management and continuous renal replacement therapy (CRRT) initiation based on AKI risk and patient fluid accumulation. We compared outcomes pre-TF2 and post-TF2 initiation. Methods: Patients admitted from July 2017 were followed-up prospectively with the following: (i) an automated RAI result at 12 hours of admission, (ii) a conditional uNGAL order for RAI ≥8, and (iii) a CRRT initiation goal at 10% to 15% weight-based fluid accumulation. Results: A total of 286 patients comprised 304 intensive care unit (ICU) RAI+ admissions; 178 patients received CRRT over the observation period (2014-2021). Median time from ICU admission to CRRT initiation was 2 days shorter ( P < 0.002), and ≥15% pre-CRRT fluid accumulation rate was lower in the TF2 era ( P < 0.02). TF2 ICU length of stay (LOS) after CRRT discontinuation and total ICU LOS were 6 and 11 days shorter for CRRT survivors (both P < 0.02). Survival rates to ICU discharge after CRRT discontinuation were higher in the TF2 era ( P = 0.001). These associations persisted in each TF2 year; we estimate a conservative $12,500 health care cost savings per CRRT patient treated after TF2 implementation. Conclusion: We suggest that automated clinical decision support (CDS) combining risk stratification and AKI biomarker assessment can produce durable reductions in pediatric CRRT patient morbidity. (© 2023 International Society of Nephrology. Published by Elsevier Inc.) |
| Databáze: | MEDLINE |
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