Journal Article

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

Ostermann, Marlies, Wu, Chun-Yi, Liao, Hung-Wei, See, Chun Yin, Wu, Vin-Cent, Chen, Jui-Yi, Huang, Yen-Ta, Liu, Jung-Hua, Pan, Heng-Chih

2023

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Acute Kidney Injury - epidemiology / Acute renal failure / Analysis / Biomarkers / Care and treatment / Cell cycle / Clinical outcomes / Cohort analysis / Complications and side effects / Creatinine / Critical care / Critical Care Medicine / Critically ill / Emergency Medicine / Heart surgery / Hemodialysis / Humans / Intensive / Intensive care / Kidney / Kidney diseases / Medicine / Medicine & Public Health / Meta-analysis / Methods / Mortality / Neutrophils / Patient Care Bundles / Patients / Performance evaluation / Prevention / Randomized Controlled Trials as Topic / Renal replacement therapy / Renal Replacement Therapy - adverse effects / Risk factors / Septic shock / Software / Systematic review / Urine