A Multinational Observational Study Exploring Adherence With the Kidney Disease
| Autor: | Mercedes García-Alvarez, Patrick M. Honore, Mar Felipe Correoso, Marc Irqsusi, Gary Thomson, Neus Grau Novellas, Mira Küllmar, Marlies Ostermann, Eric Hoste, Carola Wempe, Melanie Meersch, John A. Kellum, Shrijit Nair, Christian Arndt, Ambra Licia Di Prima, Gudrun Kunst, Philippe Grieshaber, Sara Campos, Lui G. Forni, Camilla L'Acqua, Wim Vandenberghe, Hinnerk Wulf, Stefano Italiano, Michael Haffner, Alexander Zarbock, Fabrizio Monaco, Raphael Weiß |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Acute Lung Injury Renal function Kidney Function Tests law.invention Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Prevalence Humans Medicine Prospective Studies Cardiac Surgical Procedures Prospective cohort study Aged Monitoring Physiologic business.industry Incidence Acute kidney injury Postoperative complication Length of Stay Middle Aged medicine.disease Clinical trial Anesthesiology and Pain Medicine Creatinine Emergency medicine Female Kidney Diseases Guideline Adherence business 030217 neurology & neurosurgery Cohort study Kidney disease |
| Zdroj: | ANESTHESIA AND ANALGESIA r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 0003-2999 |
| DOI: | 10.1213/ane.0000000000004642 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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