Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial.
Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial.
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DOI：
10.1007/s00134-016-4670-3
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发表时间：
2017-11
影响因子：
38.9
通讯作者：
Zarbock A
中科院分区：
文献类型：
--
作者：
Meersch M;Schmidt C;Hoffmeier A;Van Aken H;Wempe C;Gerss J;Zarbock A
在急性肾损伤（AKI）高危患者中推荐使用护理包，尽管它们尚未被证明能改善预后。我们试图确定实施肾脏疾病改善全球结局（KDIGO）指南在肾脏生物标志物定义的高危患者中预防心脏手术相关AKI的有效性。在这项单中心试验中，我们研究了由优化容量状态和血流动力学、避免肾毒性药物和预防高危患者（定义为尿[TIMP-2]·[IGFBP7] > 0.3）组成的“KDIGO束”对接受心脏手术的高血糖的影响。主要终点是术后72小时内KDIGO标准定义的AKI发生率。次要终点包括AKI严重程度、透析需求、住院时间和30,60和90天的主要肾脏不良事件（MAKE）。与对照组相比，干预显著降低了AKI [55.1 vs. 71.7%；Arr 16.6% (95 ci 5.5-27.9%)；p = 0.004]。与对照组相比，实施捆绑治疗显著改善了不同时间点的血流动力学参数（p < 0.05），减少了高血糖（p < 0.001）和ACEi/ARBs的使用（p < 0.001）。与对照组相比，干预也显著降低了中度至重度AKI的发生率。对其他次要结局无显著影响。与标准治疗相比，KDIGO指南的实施降低了高危患者心脏手术后AKI的发生频率和严重程度。有必要进行足够有力的多中心试验来检查死亡率和长期肾脏预后。本文的在线版本（doi:10.1007/s00134-016-4670-3）包含补充材料，可供授权用户使用。
Care bundles are recommended in patients at high risk for acute kidney injury (AKI), although they have not been proven to improve outcomes. We sought to establish the efficacy of an implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guidelines to prevent cardiac surgery-associated AKI in high risk patients defined by renal biomarkers. In this single-center trial, we examined the effect of a “KDIGO bundle” consisting of optimization of volume status and hemodynamics, avoidance of nephrotoxic drugs, and preventing hyperglycemia in high risk patients defined as urinary [TIMP-2]·[IGFBP7] > 0.3 undergoing cardiac surgery. The primary endpoint was the rate of AKI defined by KDIGO criteria within the first 72 h after surgery. Secondary endpoints included AKI severity, need for dialysis, length of stay, and major adverse kidney events (MAKE) at days 30, 60, and 90. AKI was significantly reduced with the intervention compared to controls [55.1 vs. 71.7%; ARR 16.6% (95 CI 5.5–27.9%); p = 0.004]. The implementation of the bundle resulted in significantly improved hemodynamic parameters at different time points (p < 0.05), less hyperglycemia (p < 0.001) and use of ACEi/ARBs (p < 0.001) compared to controls. Rates of moderate to severe AKI were also significantly reduced by the intervention compared to controls. There were no significant effects on other secondary outcomes. An implementation of the KDIGO guidelines compared with standard care reduced the frequency and severity of AKI after cardiac surgery in high risk patients. Adequately powered multicenter trials are warranted to examine mortality and long-term renal outcomes. The online version of this article (doi:10.1007/s00134-016-4670-3) contains supplementary material, which is available to authorized users.
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影响因子：
120.7
作者：
Bove, Tiziana;Zangrillo, Alberto;Landoni, Giovanni
通讯作者：
Landoni, Giovanni
影响因子：
8.8
作者：
Dardashti, Alain;Ederoth, Per;Bjursten, Henrik
通讯作者：
Bjursten, Henrik
影响因子：
3.7
作者：
Djurkovic, Svetolik;Baracaldo, Juan C.;Haupt, Marilyn T.
通讯作者：
Haupt, Marilyn T.
DOI：
10.1186/cc11240
发表时间：
2012-06-21
期刊：
Critical care (London, England)
影响因子：
--
作者：
Ronco C;Kellum JA;Haase M
通讯作者：
Haase M
DOI：
10.1053/j.jvca.2013.06.028
发表时间：
2013-12-01
影响因子：
2.8
作者：
Landoni, Giovanni;Bove, Tiziana;Bellomo, Rinaldo
通讯作者：
Bellomo, Rinaldo