The following is a summary of “Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis,” published in the October 2023 issue of Critical Care by See et al.
Early identification of AKI and initiating kidney-protective measures in at-risk or AKI patients is a key goal of various proposed approaches. Researchers started a retrospective study to evaluate the impact of care bundles on kidney outcomes in patients with AKI.
They systematically reviewed the literature to assess the clinical effectiveness of AKI (acute kidney injury) care bundles, with or without urinary biomarkers, in recognizing and managing AKI. The main outcomes included major adverse kidney events (MAKEs), which encompassed moderate-severe AKI, the receipt of renal replacement therapy (RRT), and mortality.
The results showed 7,434 screened abstracts and 946 published. Meta-analysis of 13 studies (5 randomized controlled trials (RCTs), 8 non-RCTs) with 16,540 patients The meta-analysis showed a decrease in MAKE incidence in the AKI care bundle group (OR 0.73, 95% CI 0.66–0.81), along with reductions in 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 in RCTs with a biomarker-based approach showed reduced MAKE risk (OR 0.55, 95% CI 0.41–0.74). Network meta-analysis revealed that adding biomarkers to care bundles significantly reduced MAKE risk (OR 0.693, 95% CI 0.50–0.96), while the usual care subgroup had a notably higher risk (OR 1.29, 95% CI 1.09–1.52).
Investigators concluded that care bundles improve kidney outcomes in AKI patients, mainly when they include biomarkers.