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. 2023 Oct 9;27(1):390.
doi: 10.1186/s13054-023-04641-0.

Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis

Chun Yin See  1   2 , Heng-Chih Pan  2   3   4   5 , Jui-Yi Chen  6   7 , Chun-Yi Wu  8   9 , Hung-Wei Liao  10   11 , Yen-Ta Huang  12 , Jung-Hua Liu  13 , Vin-Cent Wu  14   15 , Marlies Ostermann  16
Affiliations

Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis

Chun Yin See et al. Crit Care. .

Abstract

Introduction: Various approaches have been suggested to identify acute kidney injury (AKI) early and to initiate kidney-protective measures in patients at risk or with AKI. The objective of this study was to evaluate whether care bundles improve kidney outcomes in these patients.

Methods: We conducted a systematic review of the literature to evaluate the clinical effectiveness of AKI care bundles with or without urinary biomarkers in the recognition and management of AKI. The main outcomes were major adverse kidney events (MAKEs) consisting of moderate-severe AKI, receipt of renal replacement therapy (RRT), and mortality.

Results: Out of 7434 abstracts screened, 946 published studies were identified. Thirteen studies [five randomized controlled trials (RCTs) and eight non-RCTs] including 16,540 patients were eligible for inclusion in the meta-analysis. Meta-analysis showed a lower incidence of MAKE in the AKI care bundle group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.66-0.81] with differences in all 3 individual outcomes [moderate-severe AKI (OR 0.65, 95% CI 0.51-0.82), RRT (OR 0.63, 95% CI = 0.46-0.88) and mortality]. Subgroup analysis of the RCTs, all adopted biomarker-based approach, decreased the risk of MAKE (OR 0.55, 95% CI 0.41-0.74). Network meta-analysis could reveal that the incorporation of biomarkers in care bundles carried a significantly lower risk of MAKE when compared to care bundles without biomarkers (OR = 0.693, 95% CI = 0.50-0.96), while the usual care subgroup had a significantly higher risk (OR = 1.29, 95% CI = 1.09-1.52).

Conclusion: Our meta-analysis demonstrated that care bundles decreased the risk of MAKE, moderate-severe AKI and need for RRT in AKI patients. Moreover, the inclusion of biomarkers in care bundles had a greater impact than care bundles without biomarkers.

Keywords: Acute kidney injury; Biomarkers; Care bundles.

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Conflict of interest statement

All authors declare no competing interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Forest plot stratified the risk of a major adverse kidney events (MAKE), b acute kidney injury (AKI), c renal replacement therapy (RRT), and d all-cause mortality associated with care bundle versus usual care. All randomized controlled trials (RCTs) and non-RCTs that met the inclusion criteria were included in the analysis. a Forest plot of MAKE from care bundle versus usual care separated based on whether they included biomarkers. b Forest plot of AKI from care bundle versus usual care separated based on whether they included biomarkers. c Forest plot of RRT from care bundle versus usual care separated based on whether they included biomarkers. d Forest plot of all-cause mortality from care bundle versus usual care separated based on whether they included biomarkers
Fig. 2
Fig. 2
Forest plot stratified the risk of a major adverse kidney events (MAKE), b acute kidney injury (AKI), c renal replacement therapy (RRT), and d all-cause mortality associated with care bundle versus usual care. All randomized controlled trials (RCTs) and non-RCTs that met the inclusion criteria were included in the analysis. a Forest plot of MAKE from care bundle versus usual care separated based on whether they included biomarkers. b Forest plot of AKI from care bundle versus usual care separated based on whether they included biomarkers. c Forest plot of RRT from care bundle versus usual care separated based on whether they included biomarkers. d Forest plot of all-cause mortality from care bundle versus usual care separated based on whether they included biomarkers
Fig. 3
Fig. 3
Forest plot stratified the risk of a major adverse kidney events (MAKEs), b acute kidney injury (AKI), c renal replacement therapy (RRT), and d all-cause mortality associated with care bundle versus usual care. Only randomized controlled trials (RCTs) that met the inclusion criteria were included in the analysis. a Forest plot of MAKEs from care bundle versus usual care with all RCTs. b Forest plot of AKI from care bundle versus usual care with all RCTs. c Forest plot of RRT from care bundle versus usual care with all RCTs. d Forest plot of all-cause mortality from care bundle versus usual care with all RCTs
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