Effect of a KDIGO-Guideline–Based Preventive Bundle on Acute Kidney Injury After Cardiac Surgery in High-Risk Patients: A Randomized Controlled Trial.
DOI:
https://doi.org/10.58889/PJCVI.5.2.26.38Keywords:
Acute Kidney Injury, Cardiac Surgical Procedures, Cardiopulmonary Bypass, Biomarkers, Randomized Controlled TrialAbstract
Background: Acute kidney injury (AKI) is a frequent and serious complication after cardiac surgery, associated with increased morbidity, mortality, and longer hospital stays. Despite various preventive strategies, no intervention has consistently reduced cardiac surgery–associated AKI (CSA-AKI). The KDIGO guidelines recommend supportive care bundles for high-risk patients, but their clinical effectiveness remains uncertain. This randomized controlled trial evaluated whether a KDIGO guideline–based supportive care bundle in biomarker-identified high-risk patients undergoing cardiac surgery reduces the incidence and severity of postoperative AKI.
Methodology: In this single-center randomized clinical trial, adult patients undergoing cardiac surgery with cardiopulmonary bypass were screened for AKI risk using urinary biomarkers TIMP-2 and IGFBP7. Patients with urinary [TIMP-2]·[IGFBP7] ≥ 0.3 were classified as high risk and randomized to receive either standard postoperative care or a KDIGO guideline–based preventive bundle, including hemodynamic optimization, avoidance of nephrotoxic drugs, strict glycemic control, and close renal monitoring. The primary outcome was AKI incidence within 72 hours post-surgery based on KDIGO criteria. Secondary outcomes included AKI severity, need for renal replacement therapy, ICU and hospital length of stay, persistent renal dysfunction, and mortality at 30, 60, and 90 days.
Results: A total of 86 patients were randomized equally between intervention and control groups. The incidence of AKI within 72 hours did not differ significantly (15/43 vs 17/43; OR 0.82, 95% CI 0.34–1.97; p = 0.824). The KDIGO bundle improved postoperative hemodynamic parameters, reduced hyperglycemia (p = 0.026), and decreased ACE inhibitor use (p < 0.001), but no significant differences were observed in AKI severity, renal replacement therapy, ICU or hospital stay, or mortality.
Conclusion: Implementation of a KDIGO-guided supportive care bundle did not significantly reduce AKI incidence or severity compared with standard care. Larger multicenter trials are needed to evaluate its impact on long-term renal outcomes and survival.
