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

doi:10.1186/s13054-023-04641-0

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Title:	Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis
Authors:	See, Chun Yin Pan, Heng-Chih Chen, Jui-Yi Wu, Chun-Yi Liao, Hung-Wei Huang, Yen-Ta Liu, Jung-Hua Wu, Vin-Cent Ostermann, Marlies
Contributors:	Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med ,Div Nephrol Natl Taiwan Univ, Grad Inst Clin Med, Coll Med Keelung Chang Gung Mem Hosp, Dept Internal Med, Div Nephrol Chang Gung Univ, Coll Med Keelung Chang Gung Mem Hosp, Community Med Res Ctr Chi Mei Med Ctr, Dept Internal Med, Div Nephrol Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Taichung Vet Gen Hosp, Dept Internal Med, Div Nephrol Asia Univ, Dept Nursing Taipei Med Univ, Wan Fang Hosp, Dept Internal Med, Div Nephrol Taipei Med Univ, Coll Med, Sch Med, Dept Internal Med,Div Nephrol Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Surg Natl Chung Cheng Univ, Dept Commun Natl Taiwan Univ Hosp, Dept Internal Med NSARF Natl Taiwan Univ Hosp Study Grp Acute Renal Guys & St Thomas NHS Fdn Trust, Kings Coll London, Dept Crit Care
Keywords:	Acute kidney injury Care bundles Biomarkers
Date:	2023
Issue Date:	2024-12-25 11:03:36 (UTC+8)
Publisher:	BMC
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.
Relation:	Critical Care, v.27, n.1, Article 390
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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