实施改善全球肾脏病预后组织（KDIGO）指南预防心脏手术后急性肾损伤：一项国际队列调查。

Implementation of the Kidney Disease Improving Global Outcomes guidelines for the prevention of acute kidney injury after cardiac surgery: An international cohort survey.

机构信息

From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany (CM, MK, MM, AZ), Department of Anaesthesiology, La Fe University and Polytechnic Hospital Valencia (APM), Department of Anaesthesiology, University Hospital Vall d ́Hebron Barcelona, Spain (SGS), Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia (EG, AI), Institute of Anaesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, Ruhr- University (VvD), Department of Cardiac Anaesthesiology and Intensive Care Medicine, German Heart Center Berlin (SO, NR), Department of Cardiac Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (SO) and Department of Intensive Care Medicine, University Hospital Vall d'Hebron Barcelona, Spain.

出版信息

Eur J Anaesthesiol. 2023 Jun 1;40(6):418-424. doi: 10.1097/EJA.0000000000001837. Epub 2023 Apr 12.

DOI:10.1097/EJA.0000000000001837

PMID:37052046

Abstract

BACKGROUND

Increasing evidence from randomised controlled trials supports the implementation of a six-measure care bundle proposed by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines in patients at high risk for acute kidney injury (AKI) to reduce its incidence after cardiac surgery.

OBJECTIVE

To assess compliance with the KDIGO bundle in clinical practice.

DESIGN

Prospective observational multinational study.

SETTING

Six international tertiary care centres, from February 2021 to November 2021.

PATIENTS

Five hundred and thirty-seven consecutive patients undergoing cardiac surgery during a 1-month observational period.

INTERVENTIONS

All patients were assessed for the postoperative implementation of the following measures: avoidance of nephrotoxic medication and radiocontrast agents whenever possible, strict glycaemic control, close monitoring of renal function, optimisation of haemodynamic and volume status and functional monitoring of haemodynamic status.

MAIN OUTCOME MEASURES

The primary endpoint was the proportion of patients receiving fully compliant care. Secondary outcomes were occurrence of AKI and major adverse kidney event rate at day 30.

RESULTS

The full care bundle was applied to 0.4% of patients. There was avoidance of nephrotoxic drugs in 15.6%, radiocontrast agents in 95.3% and hyperglycaemia in 39.6%. Close monitoring of urine output and serum creatinine was achieved in 6.3%, 57.4% underwent optimisation of volume and haemodynamic status, and 43.9% received functional haemodynamic monitoring. 27.2% developed AKI within 72 h after surgery. The average number of implemented measures was 2.6 ± 1.0 and did not differ between AKI or non-AKI patients ( P = 0.854).

CONCLUSION

Adherence with the KDIGO bundle was very low in cardiac surgery patients. Initiatives to improve guideline compliance might provide a strategy to mitigate the burden of AKI.

TRIAL REGISTRATION

www.drks.de DRKS00024204.

摘要

背景

越来越多的随机对照试验证据支持在高风险急性肾损伤（AKI）的心脏手术后患者中实施肾脏病改善全球结局（KDIGO）指南提出的六措施护理包，以降低其发病率。

目的

评估临床实践中对 KDIGO 护理包的依从性。

设计

前瞻性观察性多国研究。

设置

2021 年 2 月至 2021 年 11 月的 6 个国际三级护理中心。

患者

在观察期内的 1 个月中接受心脏手术的 537 例连续患者。

干预措施

所有患者均评估术后以下措施的实施情况：尽可能避免使用肾毒性药物和造影剂，严格控制血糖，密切监测肾功能，优化血流动力学和容量状态以及功能监测血流动力学状态。

主要观察指标

主要终点是接受完全合规护理的患者比例。次要结局是术后 30 天发生 AKI 和主要肾脏不良事件的发生率。

结果

完全护理包仅应用于 0.4%的患者。避免使用肾毒性药物的占 15.6%，造影剂的占 95.3%，高血糖的占 39.6%。有 6.3%的患者实现了尿量和血清肌酐的密切监测，57.4%的患者进行了容量和血流动力学状态的优化，43.9%的患者接受了功能血流动力学监测。术后 72 小时内有 27.2%的患者发生 AKI。实施的措施平均数量为 2.6±1.0，在 AKI 或非 AKI 患者之间没有差异（ P = 0.854）。