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Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial
Detection and timely intervention of acute kidney injury (AKI) is a major challenge worldwide. Electronic alerts for AKI may improve process- and patient-related endpoints. The present study evaluated the efficacy of an AKI electronic alert system and care bundle. This is a two-arm, prospective, clu...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573102/ https://www.ncbi.nlm.nih.gov/pubmed/37835034 http://dx.doi.org/10.3390/jcm12196391 |
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author | Iwers, Ragna Sliziuk, Veronika Haase, Michael Barabasch, Sophie Zänker, Michael Butter, Christian Haase-Fielitz, Anja |
author_facet | Iwers, Ragna Sliziuk, Veronika Haase, Michael Barabasch, Sophie Zänker, Michael Butter, Christian Haase-Fielitz, Anja |
author_sort | Iwers, Ragna |
collection | PubMed |
description | Detection and timely intervention of acute kidney injury (AKI) is a major challenge worldwide. Electronic alerts for AKI may improve process- and patient-related endpoints. The present study evaluated the efficacy of an AKI electronic alert system and care bundle. This is a two-arm, prospective, cluster-randomized, controlled trial enrolling patients with AKI (KDIGO criteria) and cardiac diseases. Patients were randomly assigned to a routine care group or intervention group (DRKS-IDDRKS00017751). Two hundred patients (age 79 years, 46% female) were enrolled, with 100 patients in each group. The primary endpoint did not differ between patients in the routine care group 0.5 (−7.6–10.8) mL/min/1.73 m(2) versus patients in the intervention group 1.0 (−13.5–15.1) mL/min/1.73 m(2), p = 0.527. Proportions of patients in both study groups with hyperkalemia, pulmonary edema, and renal acidosis were comparable. The stop of antihypertensive medication during hypotensive periods was more frequent in patients in the intervention group compared to patients in the control group, p = 0.029. The AKI diagnosis and text module for AKI in the discharge letter were more frequently documented in patients in the intervention group (40%/48% vs. 25%/34%, p = 0.034; p = 0.044, respectively). Continued intake of RAAS inhibitors and the presence of a cardiac device were independently associated with a less pronounced decrease in eGFR from admission to the lowest value. In this RCT, electronic alerts for AKI and a care bundle improved process- but not patient-related endpoints. |
format | Online Article Text |
id | pubmed-10573102 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-105731022023-10-14 Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial Iwers, Ragna Sliziuk, Veronika Haase, Michael Barabasch, Sophie Zänker, Michael Butter, Christian Haase-Fielitz, Anja J Clin Med Article Detection and timely intervention of acute kidney injury (AKI) is a major challenge worldwide. Electronic alerts for AKI may improve process- and patient-related endpoints. The present study evaluated the efficacy of an AKI electronic alert system and care bundle. This is a two-arm, prospective, cluster-randomized, controlled trial enrolling patients with AKI (KDIGO criteria) and cardiac diseases. Patients were randomly assigned to a routine care group or intervention group (DRKS-IDDRKS00017751). Two hundred patients (age 79 years, 46% female) were enrolled, with 100 patients in each group. The primary endpoint did not differ between patients in the routine care group 0.5 (−7.6–10.8) mL/min/1.73 m(2) versus patients in the intervention group 1.0 (−13.5–15.1) mL/min/1.73 m(2), p = 0.527. Proportions of patients in both study groups with hyperkalemia, pulmonary edema, and renal acidosis were comparable. The stop of antihypertensive medication during hypotensive periods was more frequent in patients in the intervention group compared to patients in the control group, p = 0.029. The AKI diagnosis and text module for AKI in the discharge letter were more frequently documented in patients in the intervention group (40%/48% vs. 25%/34%, p = 0.034; p = 0.044, respectively). Continued intake of RAAS inhibitors and the presence of a cardiac device were independently associated with a less pronounced decrease in eGFR from admission to the lowest value. In this RCT, electronic alerts for AKI and a care bundle improved process- but not patient-related endpoints. MDPI 2023-10-06 /pmc/articles/PMC10573102/ /pubmed/37835034 http://dx.doi.org/10.3390/jcm12196391 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Iwers, Ragna Sliziuk, Veronika Haase, Michael Barabasch, Sophie Zänker, Michael Butter, Christian Haase-Fielitz, Anja Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial |
title | Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial |
title_full | Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial |
title_fullStr | Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial |
title_full_unstemmed | Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial |
title_short | Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial |
title_sort | care bundle for acute kidney injury in cardiac patients: a cluster-randomized trial |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573102/ https://www.ncbi.nlm.nih.gov/pubmed/37835034 http://dx.doi.org/10.3390/jcm12196391 |
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