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

被引：169

作者：

Zarbock, Alexander ^{[1
]}

Kullmar, Mira ^{[1
]}

Ostermann, Marlies ^{[2
]}

Lucchese, Gianluca ^{[2
]}

Baig, Kamran ^{[2
]}

Cennamo, Armando ^{[2
]}

Rajani, Ronak ^{[2
]}

McCorkell, Stuart ^{[2
]}

Arndt, Christian ^{[3
]}

Wulf, Hinnerk ^{[3
]}

Irqsusi, Marc ^{[4
]}

Monaco, Fabrizio ^{[5
]}

Di Prima, Ambra Licia ^{[5
]}

Garcia Alvarez, Mercedes ^{[6
]}

Italiano, Stefano ^{[6
]}

Miralles Bagan, Jordi ^{[6
]}

Kunst, Gudrun ^{[7
]}

Nair, Shrijit ^{[7
]}

L'Acqua, Camilla ^{[8
]}

Hoste, Eric ^{[9
]}

Vandenberghe, Wim ^{[9
]}

Honore, Patrick M. ^{[10
]}

Kellum, John A. ^{[11
]}

Forni, Lui G. ^{[12
,13
]}

Grieshaber, Philippe ^{[14
]}

Massoth, Christina ^{[1
]}

Weiss, Raphael ^{[1
]}

Gerss, Joachim ^{[15
]}

Wempe, Carola ^{[1
]}

Meersch, Melanie ^{[1
]}

机构：

[1] Univ Hosp Munster, Dept Anesthesiol Intens Care Med & Pain Med, Albert Schweitzer Campus 1,Gebaude A1, D-48149 Munster, Germany

[2] Guys & St Thomas Natl Hlth Serv Fdn Hosp, Dept Crit Care, London, England

[3] Univ Hosp Marburg, Dept Anesthesiol & Intens Care Med, Marburg, Germany

[4] Univ Hosp Marburg, Dept Cardiac Surg, Marburg, Germany

[5] Ist Sci San Raffaele, Ist Ricovero & Cura Carattere Sci, Dept Anesthesia & Intens Care, Milan, Italy

[6] Hosp Santa Creu & Sant Pau, Dept Anesthesiol, Barcelona, Spain

[7] Kings Coll Hosp London, Dept Anesthet, Denmark Hill, London, England

[8] Ist Ricovero & Cura Carattere Sci, Ctr Cardiol Monzino, Dept Anesthesia & Crit Care, Milan, Italy

[9] Univ Hosp Gent, Dept Intens Care Med, Ghent, Belgium

[10] CHU Brugmann Univ Hosp, Dept Intens Care, Brussels, Belgium

[11] Univ Pittsburgh, Dept Crit Care Med, Ctr Crit Care Nephrol, Pittsburgh, PA USA

[12] Univ Surrey, Royal Surrey Cty Hosp, Dept Intens Care Med, Guildford, Surrey, England

[13] Univ Surrey, Fac Hlth Sci, Guildford, Surrey, England

[14] Univ Hosp Giessen, Dept Cardiac Surg, Giessen, Germany

[15] Univ Munster, Inst Biostat & Clin Res, Munster, Germany

来源：

ANESTHESIA AND ANALGESIA | 2021年 / 133卷 / 02期

关键词：

THERAPY;

D O I：

10.1213/ANE.0000000000005458

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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.

引用

页码：292 / 302

页数：11

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