TY - JOUR
T1 - A multinational observational study exploring adherence with the kidney disease: 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 - Novellas, Neus Grau
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 - Correoso, Mar Felipe
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
N1 - Funding Information:
Funding: The trial was supported by the European Society of Intensive Care Medicine and by the German Research Foundation (ZA428/14-1, KFO 342/1, ZA 428/18-1, ZA 428/10-1, ME 5413/1-1). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency. Conflicts of Interest: See Disclosures at the end of the article.
Funding Information:
Contribution: This author helped perform the study and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: None. Name: Eric Hoste, MD. Contribution: This author helped design the trial; perform the study; and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: E. Hoste has received traveling and lecture fees from Astute Medical, Alexion, Sopachem, and AM Pharma. Name: Wim Vandenberghe, MD. Contribution: This author helped perform the study and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: None. Name: Patrick M. Honore, MD. Contribution: This author helped perform the study and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: None. Name: John A. Kellum, MD. Contribution: This author helped design the trial and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: J. A. Kellum has received lecture fees from Astute Medical, Fresenius and Baxter, unrelated to the current study and received grant support from Astute Medical, unrelated to the current study. Name: Lui Forni, MD. Contribution: This author helped design the trial and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: L. Forni has received research funding from Baxter and Ortho Clinical Diagnostics, consultancy fees from Medibeacon/La Jolla Pharmaceuticals, and honoraria from Biomerieux/Astute. Name: Philippe Grieshaber, MD. Contribution: This author helped perform the study and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: None. Name: Carola Wempe, MSc. Contribution: This author helped design the trial; perform study coordination; and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: None. Name: Melanie Meersch, MD. Contribution: This author helped conceive the study; design the trial; perform study coordination; and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: M. Meersch has received lecture fees from Astute Medical, Fresenius, and Baxter, unrelated to the current study. Name: Alexander Zarbock, MD. Contribution: This author helped conceive the study; design the trial; and draft the manuscript, and read and approved the manuscript. Conflicts of Interest: A. Zarbock has received lecture fees from Astute Medical, Fresenius, and Baxter, unrelated to the current study and received grant support from Astute Medical, unrelated to the current study. This manuscript was handled by: Jean-Francois Pittet, MD.
Publisher Copyright:
Copyright © 2020 International Anesthesia Research Society.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
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.
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U2 - 10.1213/ANE.0000000000004642
DO - 10.1213/ANE.0000000000004642
M3 - Article
C2 - 31922998
AN - SCOPUS:85082146707
SN - 0003-2999
VL - 130
SP - 910
EP - 916
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 4
ER -