Bundled Care Strategy May Reduce Moderate to Severe AKI
Multicenter trial finds KDIGO-recommended approach lowers moderate to severe acute kidney injury; measured 90-day outcomes were similar between groups
-
By
-
Kathryn Wighton
-
April 17, 2026
-
Clinical Scorecard: Bundled Care Strategy May Reduce Moderate to Severe AKI
At a Glance
| Category | Detail |
|---|
| Condition | Moderate to Severe Acute Kidney Injury (AKI) |
| Key Mechanisms | Biomarker-guided preventive care strategy based on KDIGO recommendations. |
| Target Population | Patients aged 18 years or older with clinical risk factors for AKI undergoing major surgery. |
| Care Setting | Multicenter hospitals in Europe. |
Key Highlights
- 14% of patients in the intervention group developed moderate to severe AKI compared to 22% in the control group.
- Number needed to treat to prevent one case of AKI was 12.
- Implementation of the preventive strategy occurred in 47% of patients.
- Avoidance of hypotension and discontinuation of ACE inhibitors/ARBs were strongly associated with reduced AKI.
- Major adverse kidney events at 90 days were similar between intervention and control groups.
Guideline-Based Recommendations
Diagnosis
- Use urinary TIMP-2×IGFBP7 concentration for AKI risk stratification.
Management
- Implement hemodynamic optimization and maintain mean arterial pressure of at least 65 mmHg.
Monitoring & Follow-up
- Perform repeated assessments of fluid responsiveness every 3 hours.
Risks
- Potential limitations in generalizability due to specific patient population and resource requirements.
Patient & Prescribing Data
Patients with at least one clinical risk factor for AKI.
Avoid nephrotoxic drugs and maintain blood glucose levels between 100 mg/dL and 150 mg/dL.
Clinical Best Practices
- Discontinue ACE inhibitors and angiotensin II receptor blockers preoperatively.
- Utilize urinary catheters and central venous access for monitoring.
References
