Evidence map›Paper›PMID 28110412›Full record

Trial reportIntensive care medicine2017

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, Christoph Schmidt, Andreas Hoffmeier, Hugo Van Aken, Carola Wempe, Joachim Gerss, Alexander Zarbock

Erratum issued 2 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Intensive care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 396 papers, 21 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
396citing papers in PubMed, 21 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03244514 nacompletednot on this map

Biomarker-guided Implementation of the Cardiovascular (CV) Surgery AKI Bundle to Reduce the Occurrence of AKI After Cardiac Surgery- Prevention of AKI

TypeinterventionalSponsorUniversity Hospital MuensterRan2017 to 2020Enrolled280ConditionsAcute Kidney Injury (Nontraumatic)ArmsIntervention
NCT05667467 nacompletednot on this mapstarted 2021, after this paper: background citation

Investigation of the Effect of Care Bundle Implementation on Recovery Process in Open Heart Surgery Patients

TypeinterventionalSponsorHarran UniversityRan2021 to 2022Enrolled103ConditionsThoracic Surgery, Patient Care BundlesArmsCare Bundle Implementation
3 · Its place in the literature

Who cites it

396 citing papers in PubMed, 21 syntheses or guidelines pooled it.

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336 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Melanie MeerschDepartment of Anesthesiology, Intensive Care and Pain Medicine University, Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Christoph SchmidtDepartment of Anesthesiology, Intensive Care and Pain Medicine University, Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Andreas HoffmeierDepartment of Cardiac Surgery, University of Münster, Münster, Germany.
Hugo Van AkenDepartment of Anesthesiology, Intensive Care and Pain Medicine University, Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Carola WempeDepartment of Anesthesiology, Intensive Care and Pain Medicine University, Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Joachim GerssInstitute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
Alexander ZarbockDepartment of Anesthesiology, Intensive Care and Pain Medicine University, Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany. zarbock@uni-muenster.de.ORCID http://orcid.org/0000-0002-2124-1714

Funding

Deutsche Forschungsgemeinschaft 428/6-1
6 · The paper itself

Abstract

purposeCare 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.

methodsIn 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.

resultsAKI 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.

conclusionAn 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.

Indexed as

Practice Guidelines as TopicAcute Kidney InjuryAgedAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsBiomarkersCardiopulmonary BypassCreatinineEchocardiography, TransesophagealFemaleHemodynamic MonitoringHumansInsulin-Like Growth Factor Binding ProteinsLength of StayMaleMiddle AgedAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsBiomarkersCreatinineinsulin-like growth factor binding protein-related protein 1Insulin-Like Growth Factor Binding ProteinsTissue Inhibitor of Metalloproteinase-2Acute kidney injuryBiomarkersCardiac surgeryKDIGO guidelinesMajor adverse kidney events[TIMP-2]·[IGFBP7]

Identifiers

PMID28110412
PMCPMC5633630

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.