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Randomized Controlled Trial
. 2017 Nov;43(11):1551-1561.
doi: 10.1007/s00134-016-4670-3. Epub 2017 Jan 21.

Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial

Melanie Meersch  1 , Christoph Schmidt  1 , Andreas Hoffmeier  2 , Hugo Van Aken  1 , Carola Wempe  1 , Joachim Gerss  3 , Alexander Zarbock  4
Affiliations
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

Melanie Meersch et al. Intensive Care Med. 2017 Nov.

Erratum in

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Acute kidney injury; Biomarkers; Cardiac surgery; KDIGO guidelines; Major adverse kidney events; [TIMP-2]·[IGFBP7].

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Conflict of interest statement

Conflicts of interest

AZ has received unrestricted grant and lecture fees from Astute Medical as well as lecture fees from Fresenius and Braun. MM has received lecture fees from Astute Medical. The remaining authors declare that they have no conflicts of interest.

Funding/support

The trial is registered at http://apps.who.int/trialsearch/ (Identifier: DRKS00006139). The study was supported by the German Research Foundation (428/6-1 to AZ), the European Society of Intensive Care Medicine, the Innovative Medizinische Forschung (to MM), and an unrestricted research grant from Astute Medical.

Figures

Fig. 1
Fig. 1
Trial flowchart. Enrolled patients are randomized to study groups
Fig. 2
Fig. 2
Occurrence of cardiac surgery-associated AKI. Rate of CSA-AKI in control and intervention groups
See this image and copyright information in PMC

Comment in

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