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Acute Kidney Injury after Cardiac Surgery: The Effect of the KDIGO Bundle

Nathan, Naveen MD

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doi: 10.1213/ANE.0000000000005647
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In this issue of Anesthesia & Analgesia, Zarbock et al explore the adherence to a bundled care protocol aiming to optimize renal protection for patients undergoing cardiac surgery. The Kidney Disease: Improving Global Outcomes (KDIGO) recommendations were used to guide the management of these patients. Twelve centers across Europe participated, and patients at high risk for developing acute kidney injury (AKI) were randomized to use of the KDIGO bundle or conventional care. The bundled care approach stipulated clinical parameters for hemodynamic monitoring, fluid management, and avoidance of nephrotoxic drugs and hyperglycemia. In total, 278 patients were included in the final analysis. As seen in this infographic, 65% compliance was achieved in which all measures and parameters of the KDIGO bundle were employed. This is in contrast to only 4% utilization of the KDIGO bundle components in the control group. The secondary endpoint observed whether outcomes improved with respect to the development of AKI and although the overall incidence did not differ between groups, the occurrence of moderate to severe AKI was lower in the bundled care arm. The reader is encouraged to explore this article in detail for further insight into perioperative renoprotection.


    1. Zarbock A, Küllmar M, Ostermann M, et al. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high-risk patients identified by biomarkers: the PrevAKI-multicenter randomized controlled trial. Anesth Analg. 2021;133:292–302.
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