Clinical Report: Bundled Care Strategy May Reduce Moderate to Severe AKI

Overview

A preventive care strategy based on KDIGO recommendations significantly reduced moderate to severe acute kidney injury (AKI) within 72 hours post-major surgery. The multicenter BigpAK-2 trial demonstrated a reduction in AKI incidence from 22% in the control group to 14% in the intervention group.

Background

Acute kidney injury (AKI) is a common and serious complication following major surgery, particularly in high-risk patients. Effective prevention strategies are crucial as AKI can lead to increased morbidity and mortality. The implementation of a biomarker-guided care bundle based on KDIGO guidelines offers a promising approach to mitigate this risk.

Data Highlights

Key Findings

• Moderate to severe AKI occurred in 14% of the intervention group versus 22% in the control group.
• The number needed to treat to prevent one case of moderate to severe AKI was 12.
• Any-stage AKI was observed in 37% of the intervention group compared to 41% in the control group.
• Persistent AKI lasting more than 48 hours occurred in 39% of the intervention group versus 45% in the control group.
• Implementation of the preventive strategy was achieved in 47% of patients, increasing to 63% when strict glycemic control was excluded.
• Multivariable analysis indicated that avoiding hypotension and discontinuing ACE inhibitors and ARBs were strongly associated with reduced AKI risk.

Clinical Implications

Healthcare providers should consider implementing a KDIGO-recommended preventive care strategy for patients at high risk of AKI undergoing major surgery. Continuous monitoring and management of hemodynamic status, along with avoidance of nephrotoxic agents, are essential components of this approach.

Conclusion

The findings from the BigpAK-2 trial underscore the importance of a structured preventive strategy in reducing the incidence of AKI in high-risk surgical patients. Further research is needed to assess long-term outcomes and optimize implementation in diverse clinical settings.

References

1. Zarbock A, et al., Intensive Care Medicine, 2023 -- Bundled Care Strategy May Reduce Moderate to Severe AKI
2. Siew ED, et al., Intensive Care Medicine, 2016 -- Mitigating Acute Kidney Injury Post-Cardiac Surgery Through KDIGO Guidelines in Biomarker-Identified High-Risk Patients
3. Emerging Pharmacological Therapies for Acute Kidney Injury, Intensive Care Medicine, 2022
4. Critical Care (Springer) — Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review