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

At a Glance

Key Highlights

• 14% of patients in the intervention group developed moderate to severe AKI compared to 22% in the control group.
• Number needed to treat to prevent one case of AKI was 12.
• Implementation of the preventive strategy occurred in 47% of patients.
• Avoidance of hypotension and discontinuation of ACE inhibitors/ARBs were strongly associated with reduced AKI.
• Major adverse kidney events at 90 days were similar between intervention and control groups.

Guideline-Based Recommendations

Diagnosis

• Use urinary TIMP-2×IGFBP7 concentration for AKI risk stratification.

Management

• Implement hemodynamic optimization and maintain mean arterial pressure of at least 65 mmHg.

Monitoring & Follow-up

• Perform repeated assessments of fluid responsiveness every 3 hours.

Risks

• Potential limitations in generalizability due to specific patient population and resource requirements.

Patient & Prescribing Data

Patients with at least one clinical risk factor for AKI.

Avoid nephrotoxic drugs and maintain blood glucose levels between 100 mg/dL and 150 mg/dL.

Clinical Best Practices

• Discontinue ACE inhibitors and angiotensin II receptor blockers preoperatively.
• Utilize urinary catheters and central venous access for monitoring.

References

• The Lancet Study