Evidence map›Paper›PMID 37814334›Full record

SynthesisCritical care (London, England)2023

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

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

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 6 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Chun Yin SeeDivision of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Heng-Chih PanGraduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
Jui-Yi ChenDivision of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
Chun-Yi WuDivision of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Hung-Wei LiaoDivision of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, 11696, Taiwan.
Yen-Ta HuangDepartment of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
Jung-Hua LiuDepartment of Communication, National Chung Cheng University, Chiayi, Taiwan.
Vin-Cent WuDepartment of Internal Medicine, Clinical Research Building, National Taiwan University Hospital, 7 Chung-Shan South Road, Room 1555, Taipei, Taiwan. dr.vincentwu@gmail.com.
Marlies OstermannDepartment of Critical Care, King's College London, Guy's and St. Thomas' Foundation Trust, Westminster Bridge, London, SE1 7EH, UK. Marlies.Ostermann@gstt.nhs.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionVarious 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.

methodsWe 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.

resultsOut 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).

conclusionOur 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.

Indexed as

Acute Kidney InjuryPatient Care BundlesBiomarkersHumansKidneyRandomized Controlled Trials as TopicRenal Replacement TherapyBiomarkersAcute kidney injuryBiomarkersCare bundles

Identifiers

PMID37814334
PMCPMC10563300

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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.