ArticleCritical care (London, England)2026
Implementation of the kidney protection strategy in critically ill patients with acute kidney injury - a multi-center prospective cohort study.
Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe international Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend the implementation of a kidney protection strategy (KPS) in patients at high risk of and with Acute Kidney Injury (AKI). However, real-world implementation of this strategy in critically ill patients with AKI is unclear. We quantified timely and sustained adherence to KPS in critically ill adults with moderate-to-severe (KDIGO stage 2 or 3) AKI and explored associations with clinical outcomes.
methodsThis was a multicenter, prospective cohort study enrolling adult patients with moderate or severe AKI requiring vasopressors and/or mechanical ventilation across five centers in Europe. The primary endpoint was adherence to the KPS, which included hemodynamic monitoring, sustained optimization of mean arterial pressure (MAP) > 65 mmHg, monitoring of serum creatinine and urine output, and avoidance of hyperglycemia, radiocontrast agents and nephrotoxins when possible, within 12 h after AKI diagnosis for 48 h or until ICU discharge. Exploratory analyses examined associations between adherence and renal outcomes.
resultsA total of 258 patients were enrolled (median age 69 years [IQR 62-75]; 65% male; median SOFA 10 [IQR 8-13]). The complete KPS was implemented in 80 patients (31%; 95% CI, 25.5-37.2%). Adherence to individual components of the KPS varied widely with optimization of MAP showing the lowest implementation rate (33%). In exploratory analyses accounting for death as a competing risk, KPS adherence was associated with a lower incidence of AKD beyond day 7 (subdistribution hazard ratio [SHR] 0.64; 95% CI, 0.41-0.99; p = 0.046), a higher incidence of renal recovery at hospital discharge (SHR 6.02; 95% CI, 4.00-9.05; p < 0.0001), and a lower incidence of RRT within 30 days (SHR 0.12; 95% CI, 0.02-0.91; p = 0.04). After multivariable adjustment, the association with renal recovery remained robust (adjusted SHR 6.29; 95% CI, 3.08-12.85; p < 0.0001). A clear dose-response relationship was observed between the number of implemented KPS components and renal outcomes.
conclusionsIn 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.
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