Implementation of the kidney protection strategy in critically ill patients with acute kidney injury – a multi-center prospective cohort study
Authors' conclusion
In critically ill patients with moderate-to-severe AKI, the complete KDIGO-recommended kidney protection strategy was implemented in approximately one-third of patients, and full KPS adherence was associated with a higher rate of renal recovery at hospital discharge.
Study context
- Population
- Critically ill adults with moderate or severe (KDIGO stage 2 or 3) Acute Kidney Injury (AKI) requiring vasopressors and/or mechanical ventilation, 5 centres in Europe
- Participants
- 258 adults
- Outcome
- Adherence to the KPS (haemodynamic monitoring, sustained MAP > 65 mmHg, monitoring of serum creatinine and urine output, avoidance of hyperglycemia, radiocontrast agents and nephrotoxins when possible) within 12 h after AKI diagnosis for 48 h or until ICU discharge
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Complete kidney protection strategy (KPS) implemented, n
80 (31%) (%; 95% CI 25.5-37.2%)
Optimization of mean arterial pressure (MAP), lowest-implemented component
33%
Observational data: associations, not effects.
Further findings
AKD beyond day 7, KPS adherence (exploratory, death as competing risk)
| SHR (95% CI) | P value | ||
|---|---|---|---|
| KPS adherenceExploratory analysis | 0.64 (0.41–0.99) | P = 0.046 | |
| 0.512Subdistribution hazard ratio (log scale) |
Renal recovery at hospital discharge, KPS adherence (exploratory, death as competing risk)
| Estimate | P value | ||
|---|---|---|---|
| KPS adherenceExploratory analysis | SHR 6.02 (95% CI 4.00–9.05) | P < 0.0001 | |
| KPS adherenceAfter multivariable adjustment · exploratory analysis | adjusted SHR 6.29 (95% CI 3.08–12.85) | P < 0.0001 | |
| 0.050.21520Ratio (log scale) |
RRT within 30 days, KPS adherence (exploratory, death as competing risk)
| SHR (95% CI) | P value | ||
|---|---|---|---|
| KPS adherenceExploratory analysis | 0.12 (0.02–0.91) | P = 0.04 | |
| 0.050.21520Subdistribution hazard ratio (log scale) |
Number of implemented KPS components and renal outcomes
- Clear dose-response relationship
Original publication
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