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A multinational observational study exploring adherence with the kidney disease : improving global outcomes recommendations for prevention of acute kidney injury after cardiac surgery

(2020) ANESTHESIA AND ANALGESIA. 130(4). p.910-916
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Abstract
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.
Keywords
MORTALITY, CREATININE

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MLA
Küllmar, Mira, et al. “A Multinational Observational Study Exploring Adherence with the Kidney Disease : Improving Global Outcomes Recommendations for Prevention of Acute Kidney Injury after Cardiac Surgery.” ANESTHESIA AND ANALGESIA, vol. 130, no. 4, 2020, pp. 910–16, doi:10.1213/ane.0000000000004642.
APA
Küllmar, M., Weiß, R., Ostermann, M., Campos, S., Grau Novellas, N., Thomson, G., … Zarbock, A. (2020). A multinational observational study exploring adherence with the kidney disease : improving global outcomes recommendations for prevention of acute kidney injury after cardiac surgery. ANESTHESIA AND ANALGESIA, 130(4), 910–916. https://doi.org/10.1213/ane.0000000000004642
Chicago author-date
Küllmar, Mira, Raphael Weiß, Marlies Ostermann, Sara Campos, Neus Grau Novellas, Gary Thomson, Michael Haffner, et al. 2020. “A Multinational Observational Study Exploring Adherence with the Kidney Disease : Improving Global Outcomes Recommendations for Prevention of Acute Kidney Injury after Cardiac Surgery.” ANESTHESIA AND ANALGESIA 130 (4): 910–16. https://doi.org/10.1213/ane.0000000000004642.
Chicago author-date (all authors)
Küllmar, Mira, Raphael Weiß, Marlies Ostermann, Sara Campos, Neus Grau Novellas, Gary Thomson, Michael Haffner, Christian Arndt, Hinnerk Wulf, Marc Irqsusi, Fabrizio Monaco, Ambra Licia Di Prima, Mercedes García-Alvarez, Stefano Italiano, Mar Felipe Correoso, Gudrun Kunst, Shrijit Nair, Camilla L’Acqua, Eric Hoste, Wim Vandenberghe, Patrick M Honore, John A Kellum, Lui Forni, Philippe Grieshaber, Carola Wempe, Melanie Meersch, and Alexander Zarbock. 2020. “A Multinational Observational Study Exploring Adherence with the Kidney Disease : Improving Global Outcomes Recommendations for Prevention of Acute Kidney Injury after Cardiac Surgery.” ANESTHESIA AND ANALGESIA 130 (4): 910–916. doi:10.1213/ane.0000000000004642.
Vancouver
1.
Küllmar M, Weiß R, Ostermann M, Campos S, Grau Novellas N, Thomson G, et al. A multinational observational study exploring adherence with the kidney disease : improving global outcomes recommendations for prevention of acute kidney injury after cardiac surgery. ANESTHESIA AND ANALGESIA. 2020;130(4):910–6.
IEEE
[1]
M. Küllmar et al., “A multinational observational study exploring adherence with the kidney disease : improving global outcomes recommendations for prevention of acute kidney injury after cardiac surgery,” ANESTHESIA AND ANALGESIA, vol. 130, no. 4, pp. 910–916, 2020.
@article{8642460,
  abstract     = {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.},
  author       = {Küllmar, Mira and Weiß, Raphael and Ostermann, Marlies and Campos, Sara and Grau Novellas, Neus and Thomson, Gary and Haffner, Michael and Arndt, Christian and Wulf, Hinnerk and Irqsusi, Marc and Monaco, Fabrizio and Di Prima, Ambra Licia and García-Alvarez, Mercedes and Italiano, Stefano and Felipe Correoso, Mar and Kunst, Gudrun and Nair, Shrijit and L'Acqua, Camilla and Hoste, Eric and Vandenberghe, Wim and Honore, Patrick M and Kellum, John A and Forni, Lui and Grieshaber, Philippe and Wempe, Carola and Meersch, Melanie and Zarbock, Alexander},
  issn         = {0003-2999},
  journal      = {ANESTHESIA AND ANALGESIA},
  keywords     = {MORTALITY,CREATININE},
  language     = {eng},
  number       = {4},
  pages        = {910--916},
  title        = {A multinational observational study exploring adherence with the kidney disease : improving global outcomes recommendations for prevention of acute kidney injury after cardiac surgery},
  url          = {http://dx.doi.org/10.1213/ane.0000000000004642},
  volume       = {130},
  year         = {2020},
}

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