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. Related Resources & Content
